Korean Circ J.  2023 Aug;53(8):550-562. 10.4070/kcj.2022.0355.

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

• Kim K
• Kim HJ
• Jung SH
• Lee J
• Kim JB

• KMID: 2545152
• DOI: http://doi.org/10.4070/kcj.2022.0355

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.

Keyword

Mitral regurgitation; Tricuspid regurgitation; Cardiac valve annuloplasty; Atrial fibrillation

Figure

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  Figure 1 Kaplan-Meier curves for (A) all-cause death and (B) composite of primary outcomes.

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  Figure 2 Cumulative rates of AF recurrence in the entire cohort.AF = atrial fibrillation.

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  Figure 3 Extended Kaplan-Meier plot using time-varying covariate for the composite of primary outcomes according to postoperative AF.AF = atrial fibrillation; CI = confidence interval; HR = hazard ratio.

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  Figure 4 Cumulative rates of (A) secondary outcomes in the entire cohort and (B) in patients who underwent only MR surgery, only TR surgery, and combined MR and TR surgery.MR = mitral regurgitation; TR = tricuspid regurgitation.

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