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European Heart Journal Advance Access published online on April 21, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi272
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received October 16, 2004
Revised March 11, 2005
Accepted March 17, 2005

Clinical research

Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitation

Kosei Eguchi 1, Eiji Ohtaki 1*, Takayoshi Matsumura 1, Kaoru Tanaka 1, Tetsuya Tohbaru 1, Nobuo Iguchi 1, Kazuhiko Misu 1, Ryuta Asano 1, Masatoshi Nagayama 1, Tetsuya Sumiyoshi 1, Hitoshi Kasegawa 2, and Saichi Hosoda 1

1 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
2 Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan

* To whom correspondence should be addressed.
Eiji Ohtaki, E-mail: aj-oh{at}ohtaki-clinic.com


  Abstract

Aims To examine the impact of pre-operative atrial fibrillation (AF) on the outcome of mitral valve repair (MVR) for degenerative mitral regurgitation (MR).

Methods and results Among 392 patients with moderate to severe MR who underwent MVR between 1991 and 2002, 283 patients with isolated degenerative MR were followed for 4.7 ± 3.3 years. Of 27 deaths, nine were due to cardioembolic events and four were due to left ventricular (LV) dysfunction. When compared with patients with pre-operative AF, those with sinus rhythm (SR) had better survival (96 ± 2.1 vs. 87 ± 3.2% at 5 years, P = 0.002) and higher cardiac event-free rates (96 ± 2.0 vs. 75 ± 4.4% at 5 years, P < 0.001). In patients with pre-operative SR, observed and expected survival were similar (P = 0.811). Cox multivariable regression analysis confirmed AF [P = 0.027, adjusted hazard ratio (AHR) 2.9] and age as independently predictive of survival, and AF (P = 0.002, AHR 3.1), New York Heart Association Class, and LV fractional shortening as independently predictive of cardiac event.

Conclusion Death due to LV dysfunction was not frequent and cardioembolic events due to AF were the leading cause for cardiac death. Pre-operative AF became a strong independent predictor of survival and morbidity. Patients with pre-operative SR had excellent prognosis. The benefits of preventing cardioembolic events due to AF validate the indication of MVR for patients with high risk for AF.

Keywords: Atrial fibrillation; Echocardiography; Mitral valve repair.
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