Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Functional Insufficiency of Mitral and Tricuspid Valves Associated With Atrial Fibrillation: Impact of Postoperative Atrial Fibrillation Recurrence on Surgical Outcomes

  • Kitae Kim (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jin Kim (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung-Ho Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • JaeWon Lee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joon Bum Kim (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.12.28
  • Accepted : 2023.05.03
  • Published : 2023.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background and Objectives: To identify the factors associated with adverse outcomes following surgery for functional insufficiency of the mitral valve (MV) or tricuspid valve (TV) associated with atrial fibrillation (AF). Methods: We evaluated 100 patients (age, 66.5±10.0 years; 47 males) who consecutively underwent surgery for functional insufficiency of the MV or TV associated with AF between January 2000 and December 2020 at our center. The primary outcome was a composite endpoint of all-cause death, valve reoperation, congestive heart failure (CHF) requiring rehospitalization, and stroke. Results: During follow-up (532 patients-years [PYs]), adverse events included death in 16 (3.0%/yr), MV reoperation in 1 (0.2%/yr), CHF in 14 (2.6%/yr), and stroke in 5 (0.9%/yr) patients, demonstrating a 5-year rate of freedom from the primary endpoint of 69.5%. The rate of postoperative AF was high even in those who underwent AF ablation (n=92), with cumulative rates of 48.1% at 1 year and 60.2% at 5 years. In multivariable analyses, the primary outcome was significantly associated with age (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 1.02-1.10; p=0.005), chronic kidney disease (aHR, 7.76; 95% CI, 2.28-26.38; p=0.001), left atrial appendage exclusion (aHR, 0.35; 95% CI, 0.16-1.78; p=0.010), and postoperative AF as a time-varying covariate (aHR, 3.33; 95% CI, 1.50-7.40; p=0.003). Conclusion: Among patients undergoing surgery for functional atrioventricular insufficiency associated with AF, a significant proportion showed recurrence of AF over time after concomitant AF ablation, which was significantly associated with poor clinical outcomes.

Keywords

References

  1. Bonow RO, O'Gara PT, Adams DH, et al. 2020 Focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2020;75:2236-70.
  2. Lurz P, Stephan von Bardeleben R, Weber M, et al. Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation. J Am Coll Cardiol 2021;77:229-39.
  3. Nickenig G, Weber M, Lurz P, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019;394:2002-11.
  4. Chen J, Wang Y, Lv M, et al. Mitral valve repair and surgical ablation for atrial functional mitral regurgitation. Ann Transl Med 2020;8:1420.
  5. Shibata T, Takahashi Y, Fujii H, Morisaki A, Abe Y. Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism. Gen Thorac Cardiovasc Surg 2021;69:1041-9.
  6. Rodes-Cabau J, Taramasso M, O'Gara PT. Diagnosis and treatment of tricuspid valve disease: current and future perspectives. Lancet 2016;388:2431-42.
  7. Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging 2019;12:433-42.
  8. Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol 2019;73:2465-76.
  9. Silbiger JJ. Atrial functional tricuspid regurgitation: an underappreciated cause of secondary tricuspid regurgitation. Echocardiography 2019;36:954-7.
  10. Lee JW, Choo SJ, Kim KI, et al. Atrial fibrillation surgery simplified with cryoablation to improve left atrial function. Ann Thorac Surg 2001;72:1479-83.
  11. Kim JB, Bang JH, Jung SH, Choo SJ, Chung CH, Lee JW. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg 2011;92:1397-404.
  12. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017;14:e275-444.
  13. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:921-64.
  14. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019;32:1-64.
  15. Kwan J, Shiota T, Agler DA, et al. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation 2003;107:1135-40.
  16. Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 2005;45:381-7.
  17. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 2016;374:1932-41.
  18. Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 2016;374:344-53.
  19. Kim JB. Decision-making in transcatheter edge-to-edge repair: insights into atrial functional mitral regurgitation. J Chest Surg 2021;54:449-53.
  20. Vohra HA, Whistance RN, Magan A, Sadeque SA, Livesey SA. Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation. Eur J Cardiothorac Surg 2012;42:634-7.
  21. David TE. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease. Ann Cardiothorac Surg 2015;4:417-21.
  22. Benito-Gonzalez T, Carrasco-Chinchilla F, Estevez-Loureiro R, et al. Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation. Int J Cardiol 2021;345:29-35.
  23. Bum Kim J, Suk Moon J, Yun SC, et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure. Circulation 2012;125:2071-80.
  24. Yoo JS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair. Eur J Cardiothorac Surg 2013;43:520-5.
  25. Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery. Heart 2016;102:1206-14.
  26. Kim WK, Kim HJ, Kim JB, et al. Clinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease. Heart 2018;104:841-8.
  27. Pyo WK, Kim HJ, Kim JB, et al. Does surgical ablation of atrial fibrillation benefit patients undergoing bioprosthetic valve replacement? Semin Thorac Cardiovasc Surg 2022;34:906-15.
  28. Kakuta T, Fukushima S, Minami K, et al. Novel risk score for predicting recurrence of atrial fibrillation after the Cryo-Maze procedure. Eur J Cardiothorac Surg 2021;59:1218-25.
  29. Beukema WP, Sie HT, Misier AR, Delnoy PP, Wellens HJ, Elvan A. Predictive factors of sustained sinus rhythm and recurrent atrial fibrillation after a radiofrequency modified Maze procedure. Eur J Cardiothorac Surg 2008;34:771-5.