Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation
ABSTRACT We sought to determine the impact of preoperative or postoperative atrial fibrillation on survival, stroke, and cardiac function after mitral valvuloplasty for mitral regurgitation.
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).
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).
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.
01/2014; 3(1):62-9. DOI:10.3978/j.issn.2225-319X.2013.12.07
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ABSTRACT: Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain. Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001). Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.Circulation Journal 03/2014; 78(6). DOI:10.1253/circj.CJ-13-1533 · 3.69 Impact Factor
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ABSTRACT: Reporting methods for surgical ablation (SA) of atrial fibrillation (AF) were standardized by the Heart Rhythm Society Guidelines, stating that results should be reported only for the first 2 years following SA. The purpose of this study was to assess the outcome of SA over 5 years and determine predictors for success over that period. Data were collected prospectively for all SA (n = 787). Rhythm was verified by electrocardiogram and Holter monitoring at 3, 6, 9, 12, 18 and 24 months and yearly thereafter. Patients with rhythm status available at 2 and 5 years were included in the main analyses (n = 137). Multivariate logistic regression was used for predictors of normal sinus rhythm (NSR). Receiver operating curves compared 2- and 5-year predicted probability against observed rhythm status by year. Return to NSR at 2 years was 88% (80% off antiarrhythmic drugs) and at 5 years was 85% (71% off antiarrhythmic drugs). The majority of patients (64%) had stable NSR over 5 years. The only predictor for 2-year NSR was smaller left atrial size (odds ratio [OR] = 0.40, P = 0.044). Predictors for 5-year NSR were smaller left atrial size (OR = 0.28, P = 0.002), age (OR = 0.91, P = 0.031) and length of hospital stay (OR = 0.85, P = 0.026). This study demonstrated stable results of SA for AF over time with somewhat different predictors for 2- and 5-year NSR in a group of patients with complete follow-up at both time points. Accurate models to determine predictors for success of SA more than 2 years after surgery are essential to better understand long-term outcome for patients with AF.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2014; DOI:10.1093/ejcts/ezu059 · 2.81 Impact Factor