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J Thorac Cardiovasc Surg 2000;119:790-794
© 2000 The American Association for Thoracic Surgery

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

PRESERVATION OF THE RIGHT ATRIAL APPENDAGE IMPROVES REDUCED PLASMA ATRIAL NATRIURETIC PEPTIDE LEVELS AFTER THE MAZE PROCEDURE

From the National Cardiovascular Center Research Institute,^a the Division of Cardiovascular Surgery and Hypertension,^b and the Department of Cardiovascular Medicine,^c Okayama University Medical School, Okayama, Japan.

Address for reprints: Fumiki Yoshihara, MD, National Cardiovascular Center, Research Institute, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.

Objectives: The present study was conducted to determine whether preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and whether the increase of plasma atrial natriuretic peptides improves the ability of the kidneys to excrete the fluid load after the operation.
Methods: We evaluated 42 patients who underwent the maze procedure. The right atrial appendage was preserved in 22 patients but not in 20. Blood samples were obtained before and after the operation for measurement of atrial natriuretic peptides. To evaluate the influence of atrial natriuretic peptides on the ability of the kidneys, we also measured body weight, fluid balance, and the doses of furosemide and dopamine administered after the operation.
Results: The restoration to sinus rhythm at 1 month after was comparable in the two groups. Plasma atrial natriuretic peptide levels significantly increased after the operation in patients in whom the right atrial appendage was preserved (1 day after: 23.4 ± 17.8 vs 3 days after: 42.7 ± 23.6 and 7 days after: 36.3 ± 23.7 pg/mL, P < .05) but not in patients in whom the right atrial appendage was not preserved (1 day after: 20.0 ± 19.6, 3 days after: 28.5 ± 19.3, and 7 days after: 23.0 ± 16.1 pg/mL). Furthermore, plasma atrial natriuretic peptide levels were significantly lower in patients in whom the right atrial appendage was not preserved than in patients in whom the right atrial appendage was preserved at 3 and 7 days after the operation. The fluid balance during the first 7 days of the postoperative period was comparable in the two groups, although the total dose of dopamine used in the same period was significantly smaller in patients in whom the right atrial appendage was preserved than in patients in whom the right atrial appendage was not preserved (155.3 ± 119.0 vs 244.9 ± 129.0 µg/kg, P < .05).
Conclusions: The present study showed that preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and that increased plasma atrial natriuretic peptides may improve the ability of the kidneys to excrete the fluid load after the operation.

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