Surgical strategy and outcomes for atrial functional mitral regurgitation: All functional mitral regurgitation is not the same!

Atrial functional mitral regurgitation: prevalence, characteristics and outcomes from the National Echo Database of Australia

“… 23 31 32 Mitral edge-to-edge repair has been demonstrated to be safe and effective in AFMR cohorts, demonstrating durable reduction in MR severity, positive mitral annular remodelling and rates of a composite outcome of all-cause death or HF hospitalisations ranged between 55% and 78%. 23 33 34 Reduction of AFMR through targeted intervention may represent a potential therapeutic avenue for patients with HFpEF and AF; future studies are needed to explore this hypothesis further.…”

“…Significant MR in the setting of preserved LV function, normal mitral valve leaflet appearance and a dilated mitral annulus likely represents AFMR, particularly in elderly female patients with a history of AF. Clinicians making this diagnosis should be aware of mechanisms and relative prognosis compared with VFMR, use medical management including addressing lifestyle factors, diuretics and blood pressure control, 5 29 and evaluate suitability for potentially effective interventions in symptomatic AFMR, such as AF ablation, surgical repair (mitral annuloplasty), 23 30 and transcatheter edge-to-edge repair. 23 31 32 Mitral edge-to-edge repair has been demonstrated to be safe and effective in AFMR cohorts, demonstrating durable reduction in MR severity, positive mitral annular remodelling and rates of a composite outcome of all-cause death or HF hospitalisations ranged between 55% and 78%.…”

“…Clinicians making this diagnosis should be aware of mechanisms and relative prognosis compared with VFMR, use medical management including addressing lifestyle factors, diuretics and blood pressure control, 5 29 and evaluate suitability for potentially effective interventions in symptomatic AFMR, such as AF ablation, surgical repair (mitral annuloplasty), 23 30 and transcatheter edge-to-edge repair. 23 31 32 Mitral edge-to-edge repair has been demonstrated to be safe and effective in AFMR cohorts, demonstrating durable reduction in MR severity, positive mitral annular remodelling and rates of a composite outcome of all-cause death or HF hospitalisations ranged between 55% and 78%. 23 33 34 Reduction of AFMR through targeted intervention may represent a potential therapeutic avenue for patients with HFpEF and AF; future studies are needed to explore this hypothesis further.…”

Tricuspid surgery at the time of LVAD implant: A critique

“…Atrial fibrillation associated TR is a distinct group of LVAD patients in which concomitant tricuspid valve surgery may be warranted. The Michigan group has recently demonstrated that functional MR related to atrial fibrillation and characterized by a dilated left atrium had excellent survival and low recurrence after annuloplasty ( 34 ). Importantly, patients with “atrial MR” had preserved left ventricular end-diastolic volumes (LVEDV < 5 cm).…”

Going further of mitral ring annuloplasty: the role of surgery in atrial functional mitral regurgitation

“…After a follow-up period of nearly two years, the work of Deferm and the work of Wagner (6,7) found that 7% and 6% of moderate/severe MR recurrences occurred respectively. MR repairs with ring annuloplasty alone have been suggested to be not sufficient in AFMR (8), in which case leaflet augmentation or valve replacement could play a role.…”