Key result
Preoperative left atrial area >30 cm² was associated with increased mortality compared to ≤25 cm² in patients undergoing mitral valve repair (adjusted HR 2.20; 95% CI 1.03-4.90; p=0.042).
Why the study?
While left atrial enlargement predicts mortality in medically managed mitral regurgitation from mitral valve prolapse, no study had specifically assessed its prognostic value in patients undergoing mitral valve repair.
Does preoperative left atrial enlargement predict mortality in patients in sinus rhythm undergoing surgical valve repair for severe mitral regurgitation due to mitral valve prolapse?
Cohort (n=305)
Does preoperative left atrial enlargement predict mortality in patients in sinus rhythm undergoing surgical valve repair for severe mitral regurgitation due to mitral valve prolapse?
Preoperative left atrial area >30 cm² is an independent predictor of long-term mortality in patients in sinus rhythm undergoing mitral valve repair for severe mitral regurgitation, suggesting surgery should be considered before this threshold is reached.
May aid postoperative risk stratification in mitral repair; leaves open whether earlier intervention improves survival.
Background: Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp). Objective: We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP. Methods: We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm² (reference group), LA 26–30 cm², and LA >30 cm². Results: Compared with patients with an LA area ≤25 cm², those with an LA area >30 cm² had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm² was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03–4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm² was not (adjusted HR = 1.37, 95% CI 0.56–3.56; p = 0.52). Conclusion: LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm².
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Szymanski et al. (2019) conducted a cohort in Severe mitral regurgitation due to mitral valve prolapse (n=305). Left atrial area >30 cm² vs. Left atrial area ≤25 cm² was evaluated on 10-year survival and mortality (HR 2.20, 95% CI 1.03-4.90, p=0.042). Preoperative left atrial area >30 cm² was associated with increased mortality compared to ≤25 cm² in patients undergoing mitral valve repair (adjusted HR 2.20; 95% CI 1.03-4.90; p=0.042).
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