title: The effect of preoperative atrial fibrillation on survival following mitral valve repair for degenerative mitral regurgitation.
abstract: OBJECTIVE
  There is conflicting evidence with regard to the impact of preoperative atrial fibrillation (AF) on the post mitral valve (MV) repair on the early and late outcome.
  
  
  METHODS
  A total of 349 patients undergoing various MV repair procedures for degenerative mitral regurgitation (MR) between 1997 and 2003 were studied. Preoperatively, 152 (44%) of these patients were in AF and 197 (56%) patients were in sinus rhythm (SR). The clinical features and the outcome in these two cohorts of patients were compared.
  
  
  RESULTS
  The patients in the AF group were older than their counterparts in the SR group (66+/-7 vs 62+/-9 years) (p=0.01), had a higher mean NYHA class score (2.4+/-0.6 vs 2.2+/-0.7) (p=0.04) and were more likely to have impaired left ventricular function (60% vs 36%) (p<0.0001). A similar proportion of patients in the AF (38%) and SR (30%) groups had additional cardiac surgical procedures (p=0.12). Operative mortality was 3.9% in AF group versus 0.5% in SR group (p=0.04), and operative morbidity was 27% versus 17%, respectively (p=0.03). At latest follow up, 4% of patients that were in SR preoperatively developed AF; conversely, 2% of the patients in the AF group converted to SR. The rates of recurrent grade II or III MR (4% vs 5%) (p=0.8) and MV re-operation (2.6% vs 2.5%) (p=1.0) were similar in the AF and SR groups. Kaplan-Meier survival at 7 years was 75+/-6% versus 90+/-3% (p=0.005). On Cox proportional hazards regression model, impaired LV function [(p=0.02), hazard ratio 0.25 (95% confidence intervals (C.I.) 0.078-0.84)] and AF [(p=0.03), hazard ratio 2.70 (95% C.I. 1.09-6.68)] were significant adverse predictors of survival.
  
  
  CONCLUSIONS
  This study shows that in patients undergoing MV repair for degenerative MR, preoperative AF has a major negative impact on the early and late survival.
authors.affiliation: Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.
authors.forename: Christos
authors.initials: C
authors.lastname: Alexiou
authors.forename: George
authors.initials: G
authors.lastname: Doukas
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oc
authors.forename: Bahar
authors.initials: B
authors.lastname: Oc
authors.forename: Justiaan
authors.initials: J
authors.lastname: Swanevelder
authors.forename: Nilesh J
authors.initials: NJ
authors.lastname: Samani
authors.forename: Tomasz J
authors.initials: TJ
authors.lastname: Spyt
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome