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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
When should prophylactic maze procedure be considered in patients undergoing mitral valve surgery?
John M Stulak1, Rakesh M Suri, Joseph A Dearani
1Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
The Annals of Thoracic Surgery
|April 27, 2010
Summary
Late atrial fibrillation (AF) is common after mitral valve repair, especially with pre-existing tricuspid regurgitation (TR). Surgical AF ablation may improve outcomes for high-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Late atrial fibrillation (AF) poses a risk after mitral valve surgery, even without prior arrhythmias.
- Functional tricuspid regurgitation (TR) is a common comorbidity in patients undergoing mitral valve repair.
Purpose of the Study:
- To determine the incidence and predictors of late AF in patients undergoing mitral valve repair for leaflet prolapse with functional TR.
- To assess the impact of late AF on long-term survival.
Main Methods:
- Retrospective analysis of 573 patients undergoing mitral valve repair for severe mitral regurgitation and functional TR.
- Exclusion of patients with preoperative AF or other cardiac disease.
- Assessment of late rhythm status and survival, with comparison to a cohort undergoing tricuspid valve repair.
Main Results:
- Cumulative risk of late AF was 11% at 5 years and 23% at 10 years.
- Greater than mild preoperative TR (HR, 2.3) and diabetes (HR, 4.8) were independent predictors of late AF.
- Late AF was associated with decreased late survival (HR, 4.01).
Conclusions:
- New-onset AF after mitral valve repair is significantly increased in patients with greater degrees of preoperative TR.
- Late AF negatively impacts long-term survival.
- Surgical AF ablation may be considered to mitigate adverse outcomes in high-risk patients.
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