Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve　Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Bin , XU Zhiyun , HAN Lin , SONG Zhigang , LU Fanglin , ZOU Liangjian , LANG Xilong.

Department of Thoracic and Cardiovascular Surgery， Changhai Hospital， Second Military Medical University， Shanghai 200433， P. R. China;

Corresponding author：

Keywords：

Atrial fibrillation; Rheumatic heart disease; Mitral valve replacement; Prognosis

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Abstract：　Objective　To determine the influence of preoperative atrial fibrillation （AF） on midterm and longterm clinical outcomes of patients after mitral valve replacement （MVR）.　Methods　We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital， Second Military Medical　University， from January 2000 to December 2005. According to the exclusion criteria， 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group， including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm （SR） were in the SR group， including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes， midterm and longterm mortality and morbidity of the two groups were compared.　Results　During 10 years of follow-up， there was no statistical difference in early postoperative mortality and morbidity between the two groups， but the incidence of late thromboembolism was significantly higher in AF group than that in SR group ［0.9‰ （31 patients/33 984 patient-months） vs. 0.4‰ （9 patients/21 151 patient-months）， χ2=4.26， P=0.039］. Ten-year survival rate in patients in AF group was significantly lower than that in SR group （83.2% vs. 92.7%， χ2=10.26， P=0.002）. Multivariate analysis identified preoperative AF ［HR=2.878， 95% CI （1.166，4.129）］， low left ventricular ejection fraction ［HR=0.948， 95% CI （0.917，0.981）］， and old age ［HR=1.073， 95% CI （1.038，1.109）］ as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism， preoperative AF also had an adverse effect on left ventricular function， right ventricular function and tricuspid regurgitation.　Conclusion　AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.

Citation： WANG Bin,XU Zhiyun,HAN Lin,SONG Zhigang,LU Fanglin,ZOU Liangjian,LANG Xilong.. Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve　Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 610-614. doi: Copy

1.	Quader MA， Mccarthy PM， Gillinov AM， et al. Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting ? Ann Thorac Surg， 2004， 77 （5）：1514-1522.
2.	Banach M， Goch A， Misztal M， et al. Relation between postoperative mortality and atrial fibrillation before surgical revascularization--3-　year follow-up. Thorac Cardiovasc Surg， 2008， 56 （1）：20-23.
3.	Ngaage DL， Schaff HV， Mullany CJ， et al. Does preoperative atrial fibrillation influence early and late outcomes of coronary artery　bypass grafting ? J Thorac Cardiovasc Surg， 2007， 133 （1）：182-189.
4.	Ad N， Barnett SD， Haan CK， et al. Does preoperative atrial fibrillation increase the risk for mortality and morbidity after coronary artery bypass grafting? J Thorac Cardiovasc Surg， 2009， 137 （4）：901-906.
5.	Lim E， Barlow CW， Hosseinpour AR， et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation， 2001， 104 （12 Suppl 1）：I59-I63.
6.	Eguchi K， Ohtaki E， Matsumura T， et al. Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for　degenerative mitral regurgitation. Eur Heart J， 2005， 26 （18）：1866-1872.
7.	Mccarthy PM. Adjunctive procedures in degenerative mitral valve repair：tricuspid valve and atrial fibrillation surgery. Semin Thorac Cardiovasc Surg， 2007， 19 （2）：121-126.
8.	Maisel WH， Stevenson LW. Atrial fibrillation in heart failure：　epidemiology， pathophysiology， and rationale for therapy. Am J Cardiol， 2003， 91 （6A）：2D-8D.
9.	Tsang TS， Gersh BJ， Appleton CP， et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial　fibrillation in 840 elderly men and women. J Am Coll Cardiol， 2002， 40 （9）：1636-1644.
10.	Chua YL， Schaff HV， Orszulak T， et al. Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty? J Thorac　Cardiovasc Surg， 1994， 107 （2）：408-415.
11.	Schulenberg R， Antonitsis P， Stroebel A， et al. Chronic atrial fibrillation is associated with reduced survival after aortic and double valve replacement. Ann Thorac Surg， 2010， 89 （3）：738-744.
12.	Almahameed ST， Khan M， Zuzek RW， et al. Left atrial appendage exclusion and the risk of thromboembolic events following mitral valve surgery. J Cardiovasc Electrophysiol， 2007， 18 （4）：364-366.
13.	Topcuoglu MA， Haydari D， Ozturk S， et al. Plasma levels of　coagulation and fibrinolysis markers in acute ischemic stroke patients with lone atrial fibrillation. Neurol Sci， 2000， 21 （4）：235-240.
14.	Upshaw CB Jr. Hemodynamic changes after cardioversion of chronic atrial fibrillation. Arch Intern Med， 1997， 157 （10）：1070-1076.
15.	Benjamin EJ， Wolf PA， D′agostino RB， et al. Impact of atrial fibrillation on the risk of death：the Framingham Heart Study.　Circulation， 1998， 98 （10）：946-952.
16.	Kim KB， Cho KR， Sohn DW， et al. The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease. Ann Thorac Surg， 1999， 68 （3）：799-803.
17.	Shiran A， Sagie A. Tricuspid regurgitation in mitral valve disease incidence， prognostic implications， mechanism， and management. J Am Coll Cardiol， 2009， 53 （5）：401-408.
18.	Bianchi G， Solinas M， Bevilacqua S， et al. Which patient undergoing　mitral valve surgery should also have the tricuspid repair ? Interact Cardiovasc Thorac Surg， 2009， 9 （6）：1009-1020.
19.	薛清，徐志云，韩林，等. 二尖瓣成形术中轻度功能性三尖瓣反流的处理. 中国胸心血管外科临床杂志， 2011， 18 （6）：503.
20.	Kim HK， Kim YJ， Kim KI， et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid　regurgitation over time. Circulation， 2005， 112 （9 Suppl）：I14-I19.

1. 　Quader MA， Mccarthy PM， Gillinov AM， et al. Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting ? Ann Thorac Surg， 2004， 77 （5）：1514-1522.
2. 　Banach M， Goch A， Misztal M， et al. Relation between postoperative mortality and atrial fibrillation before surgical revascularization--3-　year follow-up. Thorac Cardiovasc Surg， 2008， 56 （1）：20-23.
3. 　Ngaage DL， Schaff HV， Mullany CJ， et al. Does preoperative atrial fibrillation influence early and late outcomes of coronary artery　bypass grafting ? J Thorac Cardiovasc Surg， 2007， 133 （1）：182-189.
4. 　Ad N， Barnett SD， Haan CK， et al. Does preoperative atrial fibrillation increase the risk for mortality and morbidity after coronary artery bypass grafting? J Thorac Cardiovasc Surg， 2009， 137 （4）：901-906.
5. 　Lim E， Barlow CW， Hosseinpour AR， et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation， 2001， 104 （12 Suppl 1）：I59-I63.
6. 　Eguchi K， Ohtaki E， Matsumura T， et al. Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for　degenerative mitral regurgitation. Eur Heart J， 2005， 26 （18）：1866-1872.
7. 　Mccarthy PM. Adjunctive procedures in degenerative mitral valve repair：tricuspid valve and atrial fibrillation surgery. Semin Thorac Cardiovasc Surg， 2007， 19 （2）：121-126.
8. 　Maisel WH， Stevenson LW. Atrial fibrillation in heart failure：　epidemiology， pathophysiology， and rationale for therapy. Am J Cardiol， 2003， 91 （6A）：2D-8D.
9. 　Tsang TS， Gersh BJ， Appleton CP， et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial　fibrillation in 840 elderly men and women. J Am Coll Cardiol， 2002， 40 （9）：1636-1644.
10. 　Chua YL， Schaff HV， Orszulak T， et al. Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty? J Thorac　Cardiovasc Surg， 1994， 107 （2）：408-415.
11. 　Schulenberg R， Antonitsis P， Stroebel A， et al. Chronic atrial fibrillation is associated with reduced survival after aortic and double valve replacement. Ann Thorac Surg， 2010， 89 （3）：738-744.
12. 　Almahameed ST， Khan M， Zuzek RW， et al. Left atrial appendage exclusion and the risk of thromboembolic events following mitral valve surgery. J Cardiovasc Electrophysiol， 2007， 18 （4）：364-366.
13. 　Topcuoglu MA， Haydari D， Ozturk S， et al. Plasma levels of　coagulation and fibrinolysis markers in acute ischemic stroke patients with lone atrial fibrillation. Neurol Sci， 2000， 21 （4）：235-240.
14. 　Upshaw CB Jr. Hemodynamic changes after cardioversion of chronic atrial fibrillation. Arch Intern Med， 1997， 157 （10）：1070-1076.
15. 　Benjamin EJ， Wolf PA， D′agostino RB， et al. Impact of atrial fibrillation on the risk of death：the Framingham Heart Study.　Circulation， 1998， 98 （10）：946-952.
16. 　Kim KB， Cho KR， Sohn DW， et al. The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease. Ann Thorac Surg， 1999， 68 （3）：799-803.
17. 　Shiran A， Sagie A. Tricuspid regurgitation in mitral valve disease incidence， prognostic implications， mechanism， and management. J Am Coll Cardiol， 2009， 53 （5）：401-408.
18. 　Bianchi G， Solinas M， Bevilacqua S， et al. Which patient undergoing　mitral valve surgery should also have the tricuspid repair ? Interact Cardiovasc Thorac Surg， 2009， 9 （6）：1009-1020.
19. 　薛清，徐志云，韩林，等. 二尖瓣成形术中轻度功能性三尖瓣反流的处理. 中国胸心血管外科临床杂志， 2011， 18 （6）：503.
20. 　Kim HK， Kim YJ， Kim KI， et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid　regurgitation over time. Circulation， 2005， 112 （9 Suppl）：I14-I19.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve　Replacement

Abstract Full text Figures/Tables Video References Cited by

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Content

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve Replacement

Abstract Full text Figures/Tables Video References Cited by

Format

Content

Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve　Replacement