Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis

The preoperative clinical, echocardiographic, hemodynamic and surgical data were studied from 40 consecutive patients with pure mitral stenosis and chronic atrial fibrillation who underwent surgical correction of mitral stenosis. After surgery, the patients had cardioversion of atrial fibrillation. The data of 24 patients who maintained sinus rhythm (SR) for more than 3 months (success group) were compared with the data of the 16 patients who failed to maintain SR for more than 3 months (failure group). The patients in the success group were younger (mean age 38 +/- 12 vs 47 +/- 13 years, p less than 0.05), had symptoms for a shorter time (3.0 +/- 4.3 vs 6.4 +/- 5.0 years, p less than 0.02) and had a smaller preoperative echocardiographic left atrial (LA) size (4.9 +/- 0.9 vs 5.5 +/- 1.0 cm, p less than 0.03). The correlation between duration of SR after cardioversion (range 0 to 12 months) and the preoperative data were examined with the use of the "all-possible-subsets-regression" software. The best subset of predictors of successful cardioversion included echocardiographic LA size, functional capacity, duration of symptoms and echocardiographic left ventricular fractional shortening. Patients with symptoms for more than 3 years and echocardiographic LA size of more than 5.2 cm had low rate of successful cardioversion; in this subset of patients, postoperative cardioversion should be avoided.