Late onset of atrial fibrillation in patients undergoing mitral valve repair for type II dysfunction

Kawamoto, Naonori; Fujita, Tomoyuki; Fukushima, Satsuki; Shimahara, Yusuke; Kume, Yuta; Matsumoto, Yorihiko; Yamashita, Kizuku; Kobayashi, Junjiro

doi:10.1016/j.jjcc.2017.11.010

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…33–36 Magruder et al and similar studies found increasing postoperative LAD to be an independent predictor of late-onset AF when following patients submitted to mitral valve repair, even when excluding atrial fibrillation developed in the first 6 weeks. 37,38 This supports the idea postoperative structural remodeling provides an arrhythmic substrate facilitating AF development, which in turn contributes to the remodeling process.…”

Section: Discussionsupporting

confidence: 59%

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

et al. 2020

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Background: Atrial fibrillation (AF) is the most common arrhythmia with adverse clinical outcomes. Aortic valve replacement (AVR) is one of the most frequently performed cardiac surgeries, although there is scarce evidence on arrhythmic outcomes. We aimed to evaluate AF during the first year post- isolated aortic valve replacement surgery and its clinical, analytical, and echocardiographic predictors. Methods: Severe aortic stenosis patients with no prior atrial fibrillation submitted to isolated aortic valve replacement surgery were included in our study, of which 316 remained in sinus rhythm and 24 developed AF. We performed logistic regression searching for AF predictors and a longitudinal comparison between pre and post-operative echocardiographic data. Results: Postoperative AF (POAF), diabetes, and follow-up indexed Left Atrium Diameter (iLAD) were significantly higher in the group of patients developing AF. POAF and iLAD were independent AF predictors at follow-up. No differences between groups were found regarding baseline and follow-up echocardiographic data except for indexed Left Ventricle End-diastolic Diameter (LVED), which failed to decrease after surgery in the AF group. Conclusions: POAF and iLAD independently predicted AF at 1 year following isolated AVR surgery in aortic stenosis patients with no AF history. iLVED did not decrease significantly at follow-up in AF patients, possibly reflecting adverse ventricular remodeling.

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Section: Discussionsupporting

confidence: 59%

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

et al. 2020

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“…Application of long-acting cardioplegia, such as del Nido cardioplegia, could be a solution to this problem. 26 The present overall 30-day mortality and 3-year survival rates were both 0%, with no significant differences between the 2 groups. Similar results were reported in other studies.…”

Section: Discussionmentioning

confidence: 42%

Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction　― Propensity Score-Matched Comparison ―

Kawamoto

Fukushima

Shimahara

et al. 2018

Circ J

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Background: Despite the cosmetic benefits of the minimally invasive approach for mitral disease, the clinical benefit and risk are not fully known. We investigated the benefit and risk of minimally invasive mitral valve (MV) repair for type II dysfunction using propensity score-matched analysis. Methods and Results: Since 2001, 602 patients have undergone MV repair for type II dysfunction (464 with conventional median sternotomy and 138 with the minimally invasive approach). One-to-one matched analysis using the estimated propensity score based on 23 factors resulted in 93 well-matched patient pairs. There was no in-hospital death in both groups. The operation time was significantly shorter (P=0.002), blood transfusion was less frequent (P=0.04), extubation at the day of surgery was more frequently performed (P=0.017), and the length of hospital stay was significantly shorter in the minimally invasive group than in the sternotomy group (P<0.0001). On postoperative (P=0.02) and 1-year echocardiography (P=0.04), ejection fraction was lower in the minimally invasive group than in the sternotomy group. There were no significant differences in postoperative cerebral infarction, aortic dissection, deep sternal infection, or mid-term outcome between the groups. Conclusions: Standard sternotomy and the minimally invasive approach provide similar good quality of MV repair for type II dysfunction. The minimally invasive approach is more likely to contribute to fast-track perioperative treatment than the standard sternotomy approach.

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“…Several studies reported that smaller prostheses may result in a higher mean TMPG, and may inhibit reverse remodeling of the left atrium, which caused a risk of late atrial fibrillation. 8,19,20 Stress echocardiogram showed that a slight elevation of TMPG can be a risk for postoperative impaired exercise capacity and quality of life. 6,8,21 To improve operative quality of mitral repair for DMR, elevation of TMPG must be avoided; however, the cut-off value of mean TMPG ranged from 3.0 to 5.0 mmHg, and the definition of FMS, which can be a cause of cardiac adverse events, is still undetermined.…”

Section: Discussionmentioning

confidence: 99%

Flow adjusted transmitral pressure gradient as a modified indicator of functional mitral stenosis after repair for degenerative mitral regurgitation

Hiraoka¹,

Hayashida

Totusgawa³

et al. 2022

Journal of Cardiac Surgery

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Background and Aim: After repair of degenerative mitral regurgitation (DMR), the focus is on functional mitral stenosis (FMS) when there is a decline of mitral hemodynamics. Yet, the clinical impacts and a standardized definition are still undecided. Since common mitral hemodynamic parameters are influenced by transmitral flow, the aim of this study is to seek the impact of flow adjusted transmitral pressure gradient (TMPG) by left ventricular stroke volume (LVSV) on the midterm outcomes.Methods: Three hundred one patients who had undergone isolated mitral valve repair for degenerative lesions with annuloplasty prosthesis between October 2012 and June 2019 were included. Postoperative adverse events occurred in 20 patients (6.6%). Flow adjusted TMPG was defined as TMPG/LVSV.Results: Common mitral hemodynamic parameters were not associated with adverse events. By multivariable analysis, patients' age, left ventricular ejection fraction (LVEF) and mean TMPG/LVSV were isolated as independent predictors (adjusted hazard ratio: 1.05, 0.95, and 1.16; p = .037, .005, and .035). Flow adjusted TMPG was significantly higher in the full ring group compared to the partial band group (0.051 mmHg/ml,

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Late onset of atrial fibrillation in patients undergoing mitral valve repair for type II dysfunction

Abstract: Remodeling of the atrium caused by functional mitral stenosis is important for late Af, as well as recurrent MI. To prevent these problems, avoiding selection of a small ring at primary mitral repair for type II dysfunction and durable repair are required.

Cited by 10 publications

References 26 publications

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction　― Propensity Score-Matched Comparison ―

Flow adjusted transmitral pressure gradient as a modified indicator of functional mitral stenosis after repair for degenerative mitral regurgitation

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Late onset of atrial fibrillation in patients undergoing mitral valve repair for type II dysfunction

Abstract: Remodeling of the atrium caused by functional mitral stenosis is important for late Af, as well as recurrent MI. To prevent these problems, avoiding selection of a small ring at primary mitral repair for type II dysfunction and durable repair are required.

Cited by 10 publications

References 26 publications

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction ― Propensity Score-Matched Comparison ―

Flow adjusted transmitral pressure gradient as a modified indicator of functional mitral stenosis after repair for degenerative mitral regurgitation

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Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction　― Propensity Score-Matched Comparison ―