Surgical Strategy for Atrial Functional Mitral Regurgitation With Atrial Fibrillation

Background Atrial functional mitral regurgitation (AFMR) combined with atrial fibrillation (AF) has become a significant clinical challenge. This study evaluates surgical treatment strategies based on the degree of MR and rhythm control therapy for patients with AFMR and AF. Methods This retrospective study included 145 patients with AF and MR from January 2017 to January 2023. Patients were grouped as follows: moderate atrial regurgitation (n=33), severe atrial regurgitation (SAR, n=56), and severe primary regurgitation (SPR, n=56). The group with moderate atrial regurgitation underwent thoracoscopic AF procedure with a unilateral approach, and the SAR and SPR groups received mitral valvuloplasty plus the Cox‐Maze IV procedure. Descriptive characteristics and treatment outcomes were analyzed. Results At an average follow‐up of 2.6±1.1 years, 23 patients in the group with moderate atrial regurgitation maintained sinus rhythm. MR improved in 26 patients, remained unchanged in 6 patients, and worsened in 1 patient. Sinus rhythm maintenance was associated with MR reduction ( P =0.0002). The rate of sinus rhythm maintenance in the groups with SAR and SPR was similar (SAR 79.6%, SPR 87.5%). Echocardiography in the group with SAR showed 47 patients with no MR, 4 with mild MR, and 1 with moderate MR. The left atrial diameter in the group with SAR remained larger than in the group with SPR ( P <0.001). Conclusions Rhythm control therapy is essential for treating AFMR with AF. The thoracoscopic AF procedure is effective and minimally invasive for moderate AFMR. For severe AFMR, Cox‐Maze IV combined with mitral valvuloplasty provides optimal safety and effectiveness.