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J Thorac Cardiovasc Surg 2005;129:1032-1040
© 2005 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
b Department of Cardiology, National Cardiovascular Center, Osaka, Japan
c Department of Biostatistics, National Cardiovascular Center, Osaka, Japan
d Department of Cardiothoracic Surgery, Kobe City General Hospital, Kobe, Japan
e Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
f Kitasato University Medical School, Kanagawa, Japan
Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25–28, 2004.
Received for publication May 11, 2004; revisions received October 17, 2004; accepted for publication October 28, 2004. * Address for reprints: Ko Bando, MD, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan (E-mail: kobando{at}hsp.ncvc.go.jp).
OBJECTIVE: We sought to determine the impact of preoperative or postoperative atrial fibrillation on survival, stroke, and cardiac function after mitral valvuloplasty for mitral regurgitation.
METHODS: Between 1991 and 2003, 1026 patients with nonischemic/noncardiomyopathy mitral valve regurgitation underwent mitral valve plasty in 3 centers; 663 patients remained in sinus rhythm (group A), and 363 patients had atrial fibrillation or flutter preoperatively (group B) with concomitant maze procedures (group BM, n = 163) or without maze procedures (group BN, n = 200).
RESULTS: Eight-year freedom from cardiovascular-related death was better in group A (99.3%) than group B (BM: 96.9%, BN: 81.6%) (P < .001) and also better in group BM than group BN (P = .007). The adjusted hazard ratio of group B versus group A for preoperative differences was 5.1 (95% confidence interval: 1.8–14.8). Eight-year freedom from stroke was better in group A (99.2%) than group B (BM: 98.2%, BN: 82.6%) (P < .001) and also better in group BM than group BN (P < .001). Patients with preoperative atrial fibrillation had larger left atria and left ventricular systolic dimensions. The adjunct maze procedure improved left ventricular systolic dimensions over mitral repair alone (group A vs B: P = .359; group BM vs BN: P = .001).
CONCLUSION: Preoperative permanent/persistent atrial fibrillation was associated with a dilated left atrium and reduced left ventricular function in patients with mitral regurgitation. Including the maze procedure with mitral repair improved survival, late cardiac function, and freedom from late stroke.
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