Mitral valve repair and surgical ablation for atrial functional mitral regurgitation

Abstract

Background: This observational study aimed to share our experience in the surgical management of atrial functional mitral regurgitation (AFMR).Methods: We retrospectively identified 82 AFMR patients (63.6±7.7 years) from June 2008 to November 2018 at our institution. Of these patients, 72.0% of them were classified as NYHA functional class III/IV, and all of them had persistent AF. All patients underwent mitral valve (MV) repair, and 52 (63.4%) received concomitant surgical ablation (SA). Patients were followed up for 26.1±27.6 months, and postoperative mitral regurgitation (MR) was assessed by echocardiography.Results: There was no in-hospital mortality. The overall 1-year and 3-year survival rates were 97.5% and 92.9%, respectively, and 96.1% of patients recovered to NYHA functional class I/II at the latest followup. The left atrium (LA) diameter (P<0.001), left ventricular (LV) end-diastolic diameter (P<0.001), LV end-systolic diameter (LVESD) (P<0.001) and pulmonary artery pressure (P=0.006) significantly decreased postoperatively. The overall 1-year and 3-year freedom from recurrent MR rates were 94.3% and 65.3%, respectively, and a significant difference was found between the SA group and the non-SA group (93.8% and 93.8% vs. 95.5% and 44.2%, P=0.035). In a subgroup analysis, this significant difference was only found in the small LA group (≤60 mm).Conclusions: Our results suggest that MV repair for AFMR is safe and effective. It improves heart failure symptoms and results in reverse-remodeling of both the LA and LV. Concomitant SA might benefit patients in terms of recurrent MR, especially in the small LA group (≤60 mm).

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

“…In conclusion, AFMR is a recently described disease entity with a multifaced pathophysiology. It has been speculated that it may become the most common type of MR in the future, 19 considering the fact that the prevalence of both HFpEF and AF is increasing worldwide, with a threefold rise in prevalence over the past 50 years 39 . Its definition in surgical studies broadly varies, with discordance in the inclusion/exclusion criteria for retrospectively defining AFMR patients.…”

“…Vohra et al 15 Takahashi et al 16 Takahashi et al 17 Sakaguchi et al 7 Kaneyuki et al 18 Chen et al 19 Matsumori et al 14 Balogh et al 20 Tanaka et al 13 Hirji et al 21 Carino et al 22 Inclusion criteria Chronic AF Carpentier Type 2…”

Mitral valve surgery for atrial functional mitral regurgitation: predicting recurrent mitral regurgitation and mid-term outcome

“…As mentioned above, the freedom from cardiac death rate for the MV repair group was higher than that of the MV replacement group in the long term. However, recurrent MR of a greater than mild-moderate degree has been reported in 20-35% of such patients 2-5 years after the MV repair [6,9,11], which suggest that MV repair is not sufficient for correcting MR in certain patients. Our study showed that the 5-and 10-year rates of recurrent MR were 16.8%.…”

Mitral valve repair and concomitant maze procedure versus catheter ablation in the treatment of atrial functional mitral regurgitation

“…The implementation of the maze procedure in this investigation was higher compared to those of the above-mentioned studies, which may have contributed to the postoperative maintenance of sinus rhythm. Chen et al compared mitral repair with concomitant surgical ablation to isolated mitral repair in treating patients with AFMR [ 15 ]. The results indicated that patients may benefit from a concurrent surgical ablation operation in terms of recurrent MR.…”