title: Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. kobando@hsp.ncvc.go.jp
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kasegawa
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Michinori
authors.initials: M
authors.lastname: Nasu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hirata
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D001282:Atrial Flutter / Q000150:complications*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D009017:Morbidity; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000209:etiology