Objectives: This study aimed to determine the mid-term outcomes of surgical valve repairs for atrial functional mitral regurgitation and tricuspid regurgitation in patients with atrial fibrillation.
Methods: From October 2008 to August 2016, we performed mitral and tricuspid valve repairs in 45 patients with permanent atrial fibrillation, chronic heart failure, preserved left ventricular ejection fraction, and at least moderate functional mitral regurgitation and mild functional tricuspid regurgitation. The follow-up period ranged from 56 to 3283 days (2-109 months; median 932 days).
Results: All patients underwent both mitral and tricuspid annuloplasty. Mitral regurgitation and tricuspid regurgitation improved from 2.6 ± 0.6 (0-3) and 2.0 ± 0.7 (0-3) preoperatively to 0.4 ± 0.3 (0-3) and 0.8 ± 0.5 (0-3) at the most recent echocardiography (p < 0.0001 and p < 0.0001), respectively. Further, the New York Heart Association functional class dramatically improved from 2.8 ± 0.7 to 1.5 ± 0.7 (p < 0.0001). Postoperative cardiovascular events occurred in 10 patients, including 3 with re-admissions for heart failure. The event-free rates were 93%, 87%, and 52% at 1, 3, and 5 years after surgery, respectively. The preoperative left atrial volume index was the independent predictor of postoperative cardiovascular events.
Conclusions: Our results suggest that mitral and tricuspid valve repairs lead to reductions in regurgitations and heart failure symptoms in patients with atrial functional mitral and tricuspid regurgitations. The preoperative left atrial size should be recognized as an important risk factor of postoperative cardiovascular events.
Keywords: Atrial fibrillation; Functional mitral regurgitation; Left atrium; Mitral valve repair; Tricuspid regurgitation.