Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism

Shibata, Toshihiko; Fujii, Hiromichi; Morisaki, Akimasa; Abe, Yukio

doi:10.1007/s11748-021-01629-x

Cited by 20 publications

(9 citation statements)

References 37 publications

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“…Long-standing atrial fibrillation is also associated with severe right and left atrial enlargement, usually with MR and TR, which requires additional atrial reduction surgery ( 17 ). Severe atrial enlargement leads to smoke-like flow in the atrium with a possibility of thrombosis and compression of the bronchus and lung, followed by decreased respiratory function ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Morisaki¹,

Fujii²,

Sakon³

et al. 2022

J Thorac Dis

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Background: Long-standing atrial fibrillation is associated with atrial functional mitral regurgitation (AFMR) with atriogenic tethering. We compared the outcomes of patch augmentation (PA) and valve replacement (VR) for AFMR. Methods:We retrospectively compared the data of 16 patients who underwent PA for AFMR with the data of 15 patients who underwent VR between 2008 and 2021. Patients with a left ventricular ejection fraction (LVEF) of <50% were excluded. We also performed atrial plication and left appendage closure if the patients had no weak atrial wall that led to severe bleeding. Results:The median age was 72.5 and 76.0 years in the PA and VR groups, respectively. The PA group had a longer cardiopulmonary bypass time (206 vs. 172 min, P=0.012). Although there were no differences in hospital morbidity and mortality between the PA and VR groups, one patient underwent reoperation for patch perforation in the PA group. The overall 3-year survival rate was 93.8% and 100% in the PA and VR groups, respectively (P=0.878). The 3-year rate of freedom from major adverse cardiac events was 75.0% and 53.6% in the PA and VR groups, respectively (P=0.181). Three and six patients were readmitted for congestive heart failure in the PA and VR groups, respectively. Two patients in the PA group developed severe recurrent regurgitation, including one patient who required reoperation. No patients in the VR group required reoperation. The postoperative left atrial volume index (LAVI) was associated with thromboembolic events (P=0.016).Conclusions: PA may achieve comparable outcomes to those of VR for AFMR. Operative procedures should be chosen based on each patient's background. Atrial reduction could be considered to prevent thromboembolic events.

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Section: Discussionmentioning

confidence: 99%

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Morisaki¹,

Fujii²,

Sakon³

et al. 2022

J Thorac Dis

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“…Pseudoprolapse of the anterior mitral leaflet can usually be corrected with restrictive annuloplasty. 91 The role of restoring sinus rhythm during surgery for mitral valve repair in patients with AFMR has not been clearly defined. One retrospective study found that patients who underwent concurrent Cox maze IV procedures experienced 94% freedom from recurrent MR after 3 years compared with only 44% among those who did not.…”

Section: Surgerymentioning

confidence: 99%

Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Nappi

2024

J Int Med Res

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Functional or secondary mitral regurgitation is linked to increased cardiovascular morbidity and mortality. From a mechanical perspective, secondary mitral regurgitation occurs due to an imbalance between the forces that tether the mitral leaflets and those that close them. This results in incomplete coaptation. Most commonly, functional mitral regurgitation, which occurs in both ischaemic and non-ischaemic disease states, is usually caused by dysfunction and changes in the left ventricle. Atrial functional mitral regurgitation (AFMR) is a disease state that has been more recently recognized. It occurs when mitral annular enlargement is associated with left atrial dilatation, preserving left ventricular geometry and function. AFMR is typically seen in patients with chronic atrial fibrillation or heart failure who have a conserved ejection fraction. Published reports and ongoing investigations vary in how they define AFMR. This publication examines the pathophysiology of AFMR and highlights the importance of having a common working standard for the definition of AFMR to ensure consistency in the data reported and to drive forward the much needed research into the outcomes and treatment strategies in this area. Several studies have reported that restrictive annuloplasty and transcatheter edge-to-edge repair can reduce mitral regurgitation and improve symptoms. This narrative review will explore the pathophysiology, echocardiographic diagnosis and treatment of AFMR.

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“… 91 Additional techniques, such as surgical AF ablation, LA appendage ligation, or LA plication around the MA, play an important role in this specific population of patients. 92 Surgical ablation procedures for paroxysmal and persistent AF during concomitant MV and TV surgery include full bi-atrial Cox–Maze procedure, pulmonary vein isolation, alone or combined with LA lesion sets, and hybrid procedure. 93 Patients with A-SMR undergoing surgical MV repair and concomitant Maze procedure had a lower incidence of heart failure and AF and lower recurrence rates of moderate–severe MR and TR at follow-up than those who underwent catheter ablation procedure.…”

Section: Treatment Of Atrial Secondary Tricuspid Regurgitationmentioning

confidence: 99%

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

Muraru,

Badano,

Hahn

et al. 2024

European Heart Journal

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Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%–15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.

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Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism

Cited by 20 publications

References 37 publications

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment

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