Long-Term Results of Mitral Valve Surgery for Atrial Functional Mitral Regurgitation and Predictive Factors of Pacemaker Need in Concomitant Tricuspid Valve Repair

Abstract

Abstract: Long-Term Results of Mitral Valve Surgery for Atrial Functional Mitral Regurgitation Background: Atrial functional mitral regurgitation (AFMR) has been increasingly recognized as a distinct category of secondary mitral regurgitation (MR). Mitral valve surgery may be an alternative for symptomatic patients despite optimal medical therapy. Currently, there are limited data related to mitral valve (MV) surgery in this patient population. Objectives: The objectives of this study were to describe the long-term results of surgery for AFMR and identify factors associated with poor outcomes and repair failure. Methods: A total of 125 consecutive patients with AFMR who underwent MV surgery from January 2012 to December 2021 were retrospectively reviewed. The primary composite endpoint comprised all-cause mortality, reoperation, recurrent > moderate mitral regurgitation and hospitalization for heart failure at 10 years. Kaplan-Meier method was used to estimate the event-free probability at different time points and a competing risk analysis was used to describe the cumulative incidence of adverse events. Factors associated with poor outcomes were identified using Cox proportional hazards models. Results: At 10 years, the event-free survival was 38% (22%-65%), mainly driven by all-cause mortality of 41% (16% - 59%). The cumulative rates of reoperation, recurrent > moderate mitral regurgitation and hospitalization for heart failure were 4% (1-9%), 22% (8-41%) and 12% (4-23%), respectively. Development of > moderate mitral stenosis and tricuspid regurgitation were 37% (24% - 50%) and 36% (20% - 50%), respectively. The use of flexible bands was associated with increased incidence of recurrence of > moderate mitral regurgitation. Conclusion: Mitral valve surgery may be an effective alternative for selected patients with AFMR. Remodeling rings should be the preferred strategy for mitral valve repair. Abstract: Predictive Factors of Pacemaker Need in Concomitant Tricuspid Valve Repair Background: The indications for concomitant tricuspid valve repair in patients with less than severe tricuspid regurgitation at the time of mitral valve surgery remains controversial, with concerns raised about a significant risk for development of conduction disturbances requiring pacemaker implantation. Objectives: The objective of this study is to investigate the incidence and factors associated with postoperative pacemaker implantation in patients undergoing concomitant tricuspid valve repair at the time of mitral valve surgery for degenerative mitral valve disease. Methods: A total of 1448 consecutive patients who underwent mitral valve repair with concomitant tricuspid valve repair from January 2012 to December 2021 at a single institution were retrospectively reviewed. The primary endpoint was need for pacemaker implantation within 30 days of surgery. Logistic regression was used to identify factors associated with the outcome, and poisson regression was used to evaluate the association between pacemaker implantation and hospital and intensive care unit length of stay. Results: The incidence of pacemaker implantation was 2.6%. The most common indications included atrioventricular node (AV) block and sinus node dysfunction. Age and preoperative 1st degree AV block were associated with the outcome. Need for pacemaker implantation significantly affected both hospital and intensive care unit length of stay. Conclusion: Concomitant tricuspid valve repair may be performed with a low incidence of postoperative pacemaker requirement.