Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation.

Abstract

OBJECTIVE:

We sought to determine the impact of preoperative or postoperative atrial fibrillation on survival, stroke, and cardiac function after mitral valvuloplasty for mitral regurgitation.

METHODS:

Between 1991 and 2003, 1026 patients with nonischemic/noncardiomyopathy mitral valve regurgitation underwent mitral valve plasty in 3 centers; 663 patients remained in sinus rhythm (group A), and 363 patients had atrial fibrillation or flutter preoperatively (group B) with concomitant maze procedures (group BM, n = 163) or without maze procedures (group BN, n = 200).

RESULTS:

Eight-year freedom from cardiovascular-related death was better in group A (99.3%) than group B (BM: 96.9%, BN: 81.6%) ( P < .001) and also better in group BM than group BN ( P = .007). The adjusted hazard ratio of group B versus group A for preoperative differences was 5.1 (95% confidence interval: 1.8-14.8). Eight-year freedom from stroke was better in group A (99.2%) than group B (BM: 98.2%, BN: 82.6%) ( P < .001) and also better in group BM than group BN ( P < .001). Patients with preoperative atrial fibrillation had larger left atria and left ventricular systolic dimensions. The adjunct maze procedure improved left ventricular systolic dimensions over mitral repair alone (group A vs B: P = .359; group BM vs BN: P = .001).

CONCLUSION:

Preoperative permanent/persistent atrial fibrillation was associated with a dilated left atrium and reduced left ventricular function in patients with mitral regurgitation. Including the maze procedure with mitral repair improved survival, late cardiac function, and freedom from late stroke.

• Authors: Ko Bando, Hitoshi Kasegawa, Yukikatsu Okada, Junjiro Kobayashi, Akiko Kada, Tomoki Shimokawa, Michinori Nasu, Satoshi Nakatani, Kazuo Niwaya, Osamu Tagusari, Hiroyuki Nakajima, Mitsuhiro Hirata, Toshikatsu Yagihara, Soichiro Kitamura
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 129 Issue 5 Pg. 1032-40 (May 2005) ISSN: 0022-5223 [Print] United States
• PMID: 15867777 (Publication Type: Journal Article)

Topics

• Actuarial Analysis
• Adult
• Aged
• Atrial Fibrillation (complications)
• Atrial Flutter (complications)
• Catheterization (adverse effects, methods, mortality)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Heart Valve Prosthesis Implantation (adverse effects, methods, mortality)
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Middle Aged
• Mitral Valve Insufficiency (complications, diagnostic imaging, therapy)
• Morbidity
• Multivariate Analysis
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Stroke (epidemiology, etiology)
• Survival Analysis
• Treatment Outcome
• Ultrasonography
• Ventricular Dysfunction, Left (etiology)