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(Circulation. 2001;104:I-59.)
© 2001 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Influence of Atrial Fibrillation on Outcome Following Mitral Valve Repair

Eric Lim, MBChB, MRCS; Clifford W. Barlow, DPhil, FRCS; A. Reza Hosseinpour, FRCS; Christopher Wisbey, BA; Kate Wilson, RN, BSc; Willis Pidgeon, RN; Susan Charman, MSc; John B. Barlow, HonDSc, MD, FRCP; Francis C. Wells, MS, FRCS

Department of Cardiothoracic Surgery (E.L., C.W.B., A.R.H., C.W., K.W., W.P., F.C.W.), Papworth Hospital, Papworth Everard, and the Medical Research Council Biostatistics Unit (S.C.), Institute of Public Health, Cambridge, UK, and the Division of Cardiology (J.B.B.), Department of Internal Medicine, University of Witwatesrand and Johannesburg Hospital, Johannesburg, South Africa.

Correspondence to Francis C. Wells, Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK.

Background— To investigate the outcome of patients in atrial fibrillation (AF) following mitral valve repair, clinical and echocardiographic follow-up was undertaken in 400 consecutive patients who underwent mitral valvuloplasty from 1987 to 1999.

Methods and Results— The main indications for surgery were degenerative (81.4%), endocarditis (7.1%), rheumatic (6.6%), ischemic (4.6%), and traumatic (0.3%) mitral valve disease. After excluding 6 paced patients and 1 patient in nodal rhythm, we compared the outcomes of 152 patients in AF against 241 patients in sinus rhythm. For patients in AF versus those in sinus rhythm, more AF patients were older (mean age 67.2±8.8 versus 61.9±11.8 years, respectively; P<0.001), more were assigned to a poorer New York Heart Association (NYHA) class (77.6% versus 66.0% in NYHA III/IV, respectively; P=0.01), and more demonstrated impaired ventricular function (78.9% versus 46.2% with moderate or severe impairment, respectively; P<0.001). For patients in AF versus those in sinus rhythm, there was no difference in 30-day mortality (2.0% versus 2.1%, respectively; P=0.95), repair failure (5.4% versus 3.6%, respectively; P=0.41), stroke (5.4% versus 2.2%, respectively; P=0.11), or endocarditis (2.3% versus 0.9%, respectively; P=0.27) on follow-up at a median of 2.8 years (interquartile range 1.1 to 6.0). On echocardiography, the proportion of patients with mild regurgitation or worse was 13.3% (AF patients) versus 10.8% (patients in sinus rhythm) (P=0.70). Patients in AF versus those in sinus rhythm had lower survival at 3 years (83% versus 93%, respectively) and 5 years (73% versus 88%, respectively). Univariate analysis identified factors affecting survival as AF (P=0.002), age >70 years (P=0.041), and poor ventricular function (P<0.001). However, by use of a multivariate model, only poor ventricular function remained significant (P=0.01).

Conclusions— AF does not affect early outcome or durability of mitral repair. The onset of AF may be indicative of disease progression because of its association with poor left ventricular function.

Key Words: arrhythmia • mitral valve • surgery

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