Document Detail

Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitation.
MedLine Citation:
PMID:  15845559     Owner:  NLM     Status:  MEDLINE    
AIMS: To examine the impact of pre-operative atrial fibrillation (AF) on the outcome of mitral valve repair (MVR) for degenerative mitral regurgitation (MR). METHODS AND RESULTS: Among 392 patients with moderate to severe MR who underwent MVR between 1991 and 2002, 283 patients with isolated degenerative MR were followed for 4.7+/-3.3 years. Of 27 deaths, nine were due to cardioembolic events and four were due to left ventricular (LV) dysfunction. When compared with patients with pre-operative AF, those with sinus rhythm (SR) had better survival (96+/-2.1 vs. 87+/-3.2% at 5 years, P=0.002) and higher cardiac event-free rates (96+/-2.0 vs. 75+/-4.4% at 5 years, P<0.001). In patients with pre-operative SR, observed and expected survival were similar (P=0.811). Cox multivariable regression analysis confirmed AF [P=0.027, adjusted hazard ratio (AHR) 2.9] and age as independently predictive of survival, and AF (P=0.002, AHR 3.1), New York Heart Association Class, and LV fractional shortening as independently predictive of cardiac event. CONCLUSION: Death due to LV dysfunction was not frequent and cardioembolic events due to AF were the leading cause for cardiac death. Pre-operative AF became a strong independent predictor of survival and morbidity. Patients with pre-operative SR had excellent prognosis. The benefits of preventing cardioembolic events due to AF validate the indication of MVR for patients with high risk for AF.
Kosei Eguchi; Eiji Ohtaki; Takayoshi Matsumura; Kaoru Tanaka; Tetsuya Tohbaru; Nobuo Iguchi; Kazuhiko Misu; Ryuta Asano; Masatoshi Nagayama; Tetsuya Sumiyoshi; Hitoshi Kasegawa; Saichi Hosoda
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-04-21
Journal Detail:
Title:  European heart journal     Volume:  26     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-29     Completed Date:  2006-02-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1866-72     Citation Subset:  IM    
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / complications*,  mortality
Cause of Death
Disease-Free Survival
Follow-Up Studies
Hospital Mortality
Middle Aged
Mitral Valve / surgery*
Mitral Valve Insufficiency / mortality,  surgery*
Preoperative Care
Ventricular Dysfunction, Left / etiology,  mortality

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