• Victor X Mosquera, Alberto Bouzas-Mosquera, Miguel González-Barbeito, Victor Bautista-Hernandez, Javier Muñiz, Nemesio Alvarez-García, and José J Cuenca-Castillo.
• Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. Electronic address: Victor.X.Mosquera.Rodriguez@sergas.es.
• J. Thorac. Cardiovasc. Surg. 2017 Jun 1; 153 (6): 1275-1284.e7.

ObjectivesThe enlargement of the left atrium has been identified as a marker of chronically increased left ventricular filling pressure and left ventricular diastolic dysfunction. This study aims to evaluate the association of indexed left atrial diameter with stroke, cardiovascular mortality, the combined event, and all-cause mortality in patients who underwent aortic valve surgery.MethodsIndexed left atrial diameter was measured in 2011 adult patients (mean age, 70.9 ± 10.8 years; 58.7% were men) who underwent aortic valve surgery between January 2008 and March 2016.ResultsOn the basis of the criteria of the American Society of Echocardiography, indexed left atrial diameter was normal in 64% of patients, mildly enlarged in 12.4% of patients, moderately enlarged in 9.2% of patients, and severely enlarged in 14.3% of patients. Over a mean follow-up period of 3.2 ± 2.1 years, there were 334 deaths and 97 strokes. Cardiovascular mortality survival at 5 years among patients with normal, mild, moderate, and severe left atrial enlargement was 91.6%, 86.8%, 77.9%, and 77.4%, respectively (P < .001). After covariable adjustment, Cox regression analysis showed indexed left atrial diameter as an independent predictor of all-cause mortality (hazard ratio per 1-cm/m2 increment, 1.545; 95% confidence interval, 1.252-1.906, P < .001), cardiovascular death (hazard ratio per 1-cm/m2 increment, 1.971; 95% confidence interval, 1.541-2.520; P < .001), and the combined event (hazard ratio per 1-cm/m2 increment, 1.673; 95% confidence interval, 1.321-2.119; P < .001).ConclusionsIndexed left atrial diameter is a strong predictor of long-term outcomes in patients with aortic valve diseases who undergo surgery.Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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