title: Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse.
abstract: The aim of the study was to assess the impact of atrial fibrillation (AF) on outcome in patients who underwent mitral valve repair (MVRp) for mitral valve prolapse (MVP). Four hundred and forty-three consecutive patients underwent MVRp for organic mitral regurgitation due to MVP. Echocardiography was performed preoperatively and after surgery. Postoperative left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Before surgery, 187 patients (42%) had preoperative AF. After surgery, LVEF significantly decreased from 67 ± 9% to 56 ± 10% (p <0.0001). Compared with patients in sinus rhythm (SR), those in AF were significantly older (p <0.0001), had more severe symptoms (p = 0.004), had lower LVEF (p = 0.002), and higher EuroSCORE (p = 0.05). Compared with patients in SR, patients with AF had significantly lower 10-year survival (64 ± 4% vs 83 ± 3%, p = 0.001). On multivariate analysis, preoperative AF was identified as an independent predictor of overall mortality (hazard ratio 1.67; 95% confidence interval 1.15 to 2.42; p = 0.007). At 10 years, patients with paroxysmal AF had lower survival and higher heart failure rate than patients in SR (78 ± 3% vs 66 ± 6%) but had a better outcome compared with those with permanent AF (66 ± 6% vs 53 ± 6%, p = 0.022). Patients with AF had a significantly higher rate of postoperative LVD (23.3% vs 13.4%, p = 0.007). In conclusion, preoperative AF is a predictor of long-term mortality and postoperative LVD after MVRp for MVP. To improve postoperative outcome, surgery in these patients should be performed before onset of AF.
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.affiliation: Department of Cardiology, University of Liege, CHU Sart Tilman, Liège, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Fournier
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.affiliation: Department of Cardiac Surgery, University Hospital Amiens, Amiens, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Touati
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France; INSERM U1088, University of Picardie, Amiens, France. Electronic address: tribouilloy.christophe@chu-amiens.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*