Key result
Mitral valve repair is linked to smaller left atria despite ~13% recurrent MR with LV dilatation.
Why the study?
Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure remain limited.
Observational (n=40)
No
Absolute Event Rate: 54% vs 60%
p-value: p=<0.001
Mitral valve repair for atrial functional mitral regurgitation reduces left atrial and ventricular dimensions, but recurrent MR can occur in patients with preoperative LV dilatation, suggesting tricuspid annuloplasty may be needed to prevent long-term tricuspid regurgitation.
May warrant caution with mitral repair in LV dilatation due to recurrence risk; leaves open optimal adjunctive strategies in atrial functional MR.
BACKGROUND: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. METHODS: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. RESULTS: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. CONCLUSIONS: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.
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Kaneyuki et al. (2020) conducted an observational in Atrial functional mitral regurgitation (n=40). Mitral valve repair (mitral ring annuloplasty) vs. Preoperative baseline was evaluated on Left atrial dimension (mm) (p=<0.001). Mitral valve repair significantly decreased left atrial dimensions from 60 mm to 54 mm, but recurrent mitral regurgitation occurred in 13% of patients with preoperative left ventricular dilatation.
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