Durability of Annuloplasty in Patients with Atrial Functional Mitral Regurgitation Associated with Atrial Fibrillation.

OBJECTIVE: To determine the durability of mitral valve repair with complete ring or flexible band annuloplasty in patients with atrial functional mitral regurgitation due to atrial fibrillation and identify risk factors associated with postoperative mitral regurgitation recurrence.

METHODS: From 1/1/2000-1/1/2023, 194 adults with history of atrial fibrillation underwent mitral valve repair with annuloplasty alone for moderate/severe atrial functional mitral regurgitation. Exclusion criteria were prior cardiac surgery, additional repair techniques, ejection fraction<45%, ischemic heart disease, aortic valve disease, mitral annular calcification, and concomitant procedures other than surgical ablation or tricuspid repair/replacement. Durability of annuloplasty was assessed using longitudinal analysis of postoperative echo data.

RESULTS: Complete ring annuloplasty was performed in 126/194(65%) patients; partial ring(posterior band) was chosen in 68/194(35%). Concomitantly, 64%(124/194) of patients underwent tricuspid valve surgery and 89%(173/194) an atrial fibrillation procedure, including biatrial Cox-Maze III/IV lesion set in 88%(152/173) and pulmonary vein isolation in 12%(21/173). All patients were discharged with no/trace mitral regurgitation. Freedom from moderate/severe mitral regurgitation after repair with annuloplasty alone was 89% at 10 years, and no significant differences were noted between complete vs. partial ring annuloplasty(early P=0.41, late P=0.92). Forty-eight percent of patients developed atrial fibrillation 3 or more months after surgery, and presence of postoperative atrial fibrillation was not associated with higher likelihood of recurrence of mitral regurgitation(P=0.15). Freedom from mitral reintervention was 96% at 10 years(Graphical Abstract).

CONCLUSIONS: In appropriate patients with atrial functional mitral regurgitation, long-term durability of annuloplasty is excellent with complete ring and posterior band annuloplasty techniques.