Late onset of atrial fibrillation in patients undergoing mitral valve repair for type II dysfunction. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Kawamoto, Naonori; Fujita, Tomoyuki; Fukushima, Satsuki; Shimahara, Yusuke; Kume, Yuta; Matsumoto, Yorihiko; Yamashita, Kizuku; Kobayashi, Junjiro
• Is Part Of: Journal of cardiology. Volume 71:Issue 4(2018)
• Page Start: 346
• Page End: 351
• Publication Date: 2018-04
• Subjects: Mitral valve repair -- Late atrial fibrillation -- Functional mitral stenosis -- Recurrent mitral insufficiency; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2017.11.010
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: The incidence of late atrial fibrillation (Af) after mitral valve repair was 6% at 5 years and 17.1% at 10 years postoperatively. Small ring annuloplasty, left atrial diameter, and pressure half time in follow-up data were risk factors for late Af. Patients who had late Af developed recurrent mitral insufficiency more frequently than those who did not ( p < 0.05). Late Af did not affect long-term survival. Cerebrovascular events occurred relatively more frequently in patients with late Af. Abstract: Background: There are few reports regarding factors related to late-onset of atrial fibrillation (Af) after mitral valve repair, which can compromise long-term outcome. We analyzed the risk factors for late Af after mitral valve repair. Methods and results: Between 2001 and 2015, 318 patients (214 males; median, 57.7 years) underwent mitral valve repair for degenerative mitral insufficiency (MI) without concomitant aortic valve disease in our institute. Patients with a history of paroxysmal or chronic Af preoperatively were excluded. Serial follow-up echocardiography was used to evaluate cardiac function. The follow-up rate was 99%. The mean follow-up period was 6.0 ± 4.1 years. There was no early death and there were nine late deaths. A total of 29 (9.1%) patients developed late Af. Freedom from late Af was 94.0% at 5 years and 82.9% at 10 years. Small ring annuloplasty, left atrial diameter, and pressure half time, which were measured at follow-up echocardiography, were considered as significant ( p < 0.05) risk factors for late Af. Patients who had late Af developed recurrent MI more frequently than those who did not ( p < 0.05). Conclusions: Remodeling of the atrium caused by functional mitral stenosis is important for late Af, as well as recurrent MI. To prevent these problems, avoiding selection of a small ring at primary mitral repair for type II dysfunction and durable repair are required.