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Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation.

Abstract

BACKGROUND

Surgical ring annuloplasty is generally performed in patients with symptomatic atrial functional mitral regurgitation (MR) caused by long-standing atrial fibrillation (AF). However, its clinical results have not been well reported.

METHODS

Twenty consecutive patients with atrial functional MR (mean age of 68 ± 9 years) and a left ventricular (LV) ejection fraction (EF) greater than 50% underwent mitral annuloplasty. Concomitant procedures included tricuspid valve surgery in 16 patients, AF ablation in 13 patients, and coronary artery bypass grafting in 2 patients. We reviewed the clinical outcomes of those patients and investigated the specific preoperative echocardiographic findings related to MR recurrence.

RESULTS

At discharge, the mean left atrial (LA) volume index and mean tricuspid regurgitation peak gradient had significantly decreased from 94 ± 59 mL/m 2 to 58 ± 30 mL/m 2 and from 34 ± 11mm Hg to 23 ± 5mm Hg, respectively. During the follow-up period of 28 ± 17 months, the New York Heart Association functional class significantly improved from 2.3 ± 0.6 to 1.3 ± 0.6. Four patients developed recurrent MR, and of those, two required reoperation. Those with recurrent MR had a significantly larger preoperative LV dimension than those without recurrent MR. Preoperative three-dimensional transesophageal echocardiography was performed in 12 patients, revealing a greater degree of leaflet tethering in patients with recurrent MR than that in patients without recurrent MR.

CONCLUSIONS

In patients with the combination of atrial functional MR, left ventricular dilatation and excessive leaflet tethering, mitral annuloplasty alone may not be sufficient to achieve long-term correction of MR.

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  • Authors+Show Affiliations

    ,

    Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.

    ,

    Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

    ,

    Department of Surgery II, Kochi Medical School, Kochi, Japan.

    ,

    Department of Surgery II, Kochi Medical School, Kochi, Japan.

    ,

    Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

    ,

    Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

    ,

    Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

    Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.

    Source

    Journal of cardiac surgery : 2019 Jun 24 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31233252

    Citation

    Sakaguchi, Taichi, et al. "Mitral Annuloplasty for Atrial Functional Mitral Regurgitation in Patients With Chronic Atrial Fibrillation." Journal of Cardiac Surgery, 2019.
    Sakaguchi T, Totsugawa T, Orihashi K, et al. Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. J Card Surg. 2019.
    Sakaguchi, T., Totsugawa, T., Orihashi, K., Kihara, K., Tamura, K., Hiraoka, A., ... Yoshitaka, H. (2019). Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. Journal of Cardiac Surgery, doi:10.1111/jocs.14136.
    Sakaguchi T, et al. Mitral Annuloplasty for Atrial Functional Mitral Regurgitation in Patients With Chronic Atrial Fibrillation. J Card Surg. 2019 Jun 24; PubMed PMID: 31233252.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. AU - Sakaguchi,Taichi, AU - Totsugawa,Toshinori, AU - Orihashi,Kazumasa, AU - Kihara,Kazuki, AU - Tamura,Kentaro, AU - Hiraoka,Arudo, AU - Chikazawa,Genta, AU - Yoshitaka,Hidenori, Y1 - 2019/06/24/ PY - 2019/6/25/entrez KW - atrial fibrillation KW - atrial functional mitral regurgitation KW - functional mitral regurgitation KW - leaflet tethering KW - mitral regurgitation KW - mitral valve repair JF - Journal of cardiac surgery JO - J Card Surg N2 - BACKGROUND: Surgical ring annuloplasty is generally performed in patients with symptomatic atrial functional mitral regurgitation (MR) caused by long-standing atrial fibrillation (AF). However, its clinical results have not been well reported. METHODS: Twenty consecutive patients with atrial functional MR (mean age of 68 ± 9 years) and a left ventricular (LV) ejection fraction (EF) greater than 50% underwent mitral annuloplasty. Concomitant procedures included tricuspid valve surgery in 16 patients, AF ablation in 13 patients, and coronary artery bypass grafting in 2 patients. We reviewed the clinical outcomes of those patients and investigated the specific preoperative echocardiographic findings related to MR recurrence. RESULTS: At discharge, the mean left atrial (LA) volume index and mean tricuspid regurgitation peak gradient had significantly decreased from 94 ± 59 mL/m 2 to 58 ± 30 mL/m 2 and from 34 ± 11mm Hg to 23 ± 5mm Hg, respectively. During the follow-up period of 28 ± 17 months, the New York Heart Association functional class significantly improved from 2.3 ± 0.6 to 1.3 ± 0.6. Four patients developed recurrent MR, and of those, two required reoperation. Those with recurrent MR had a significantly larger preoperative LV dimension than those without recurrent MR. Preoperative three-dimensional transesophageal echocardiography was performed in 12 patients, revealing a greater degree of leaflet tethering in patients with recurrent MR than that in patients without recurrent MR. CONCLUSIONS: In patients with the combination of atrial functional MR, left ventricular dilatation and excessive leaflet tethering, mitral annuloplasty alone may not be sufficient to achieve long-term correction of MR. SN - 1540-8191 UR - https://www.unboundmedicine.com/medline/citation/31233252/Mitral_annuloplasty_for_atrial_functional_mitral_regurgitation_in_patients_with_chronic_atrial_fibrillation L2 - https://doi.org/10.1111/jocs.14136 DB - PRIME DP - Unbound Medicine ER -