Mid-term results of valve repairs for atrial functional mitral and tricuspid regurgitations

Abe, Yukio; Murakami, Tadahiro; Fujii, Hiromichi; Morisaki, Akimasa; Nishimura, Shinsuke; Sakon, Yoshito; Ito, Kenichi; Shintani, Ayumi; Shibata, Toshihiko

doi:10.1007/s11748-019-01203-6

Cited by 24 publications

(38 citation statements)

References 20 publications

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“…Long-standing AF is also known to cause functional secondary TR due to tricuspid annular dilatation [20]. Takahashi et al suggested that MV repair in addition to tricuspid valve repair should be considered because atrial functional MR and TR are dual-valve diseases [10]. The present study showed that 60% of the patients without tricuspid ring annuloplasty or sinus rhythm recovery using the maze procedure developed moderate or severe TR during the follow-up period.…”

Section: Discussionsupporting

confidence: 47%

“…As annular dilation by LA remodeling has been considered the main cause of atrial function MR, mitral ring annuloplasty has been the main target of surgical intervention. However, the number of studies reporting outcomes of surgical treatment for atrial functional MR is limited [6][7][8][9][10]. Thus, we aimed to review the midterm outcomes of mitral valve (MV) repair for atrial functional MR.…”

Section: Introductionmentioning

confidence: 99%

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Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Kaneyuki

Nakajima

Asakura

et al. 2020

J Cardiothorac Surg

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Background Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. Methods We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. Results Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. Conclusions Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Kaneyuki

Nakajima

Asakura

et al. 2020

J Cardiothorac Surg

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“…As the LA volume continues to increase with persistent AF, patients can develop congestive heart failure that cannot be managed with medications. Although surgical indication for atrial functional MR remains uncertain, surgical intervention has been reported to be bene cial for decreasing LA volume, severity of MR, and clinical symptoms in heart failure [6][7][8][9][10]. In addition, this study showed decreased LA dimension and LV end-diastolic dimension on follow-up echocardiography.…”

Section: Clinical Outcomesmentioning

confidence: 51%

“…The balance of bene ts and risks of the maze procedure should be taken into consideration, and further study should elucidate the reasonable indication of the maze procedure. Although the indication of LA plication also remains unclear, Takahashi et al [10] reported that one patient showed a gradual increase in the LA volume index, and this resulted in re-worsening of the PML tethering. Therefore, LA plication might prevent further PML tethering.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Mitral Valve Repair for Atrial Functional Mitral Regurgitation: A Retrospective Study

Kaneyuki¹,

Nakajima²,

Asakura³

et al. 2020

Preprint

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Background: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation.Methods: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for >1 year, preserved left ventricular ejection fraction of >40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months.Results: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95% and 86%, respectively. Conclusions: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

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“…Because sinus rhythm recovery was not su cient after the maze procedure in patients with severe LA dilatation, tricuspid ring annuloplasty is recommended for patients without considerable operative risk. Cardiac death 4 (10) Recurrent moderate or severe MR 5 (13) Re-admission for heart failure 7 (18) Cerebrovascular events 1 Freedom from re-admission for heart failure…”

Section: Discussionmentioning

confidence: 99%

Midterm results of mitral valve repair for atrial functional mitral regurgitation: A retrospective study

Kaneyuki¹,

Nakajima²,

Asakura³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation.Methods: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for >1 year, preserved left ventricular ejection fraction of >40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months.Results: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95% and 86%, respectively.Conclusions: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

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Mid-term results of valve repairs for atrial functional mitral and tricuspid regurgitations

Cited by 24 publications

References 20 publications

Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Midterm Results of Mitral Valve Repair for Atrial Functional Mitral Regurgitation: A Retrospective Study

Midterm results of mitral valve repair for atrial functional mitral regurgitation: A retrospective study

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