Surgical strategy and outcomes for atrial functional mitral regurgitation: All functional mitral regurgitation is not the same!

Autor:	Wagner CM; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Brescia AA; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Watt TMF; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Bergquist C; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Rosenbloom LM; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Ceniza NN; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Markey GE; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Ailawadi G; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Romano MA; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich., Bolling SF; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: sbolling@med.umich.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Feb; Vol. 167 (2), pp. 647-655. Date of Electronic Publication: 2022 Apr 06.
DOI:	10.1016/j.jtcvs.2022.02.056
Abstrakt:	Objective: Functional mitral regurgitation (FMR) is a cardiac pathology that causes the mitral valve to malfunction, leading to mitral regurgitation (MR). The optimal strategy for FMR remains unclear, and FMR outcomes are poor. All etiologies of FMR might not be the same, and subdividing patients with FMR caused by atrial (AFMR) versus ventricular FMR pathology might be important. Herein, we present outcomes of patients with AFMR to define this "new" population. Methods: Data of patients who underwent mitral valve repair for MR from 2000 to 2020 were reviewed. Patients with degenerative/myxomatous disease, ejection fraction <50% (ventricular FMR), and miscellaneous etiologies including endocarditis and rheumatic disease were excluded to isolate a population of "pure" AFMR patients. Descriptive characteristics and outcomes data were analyzed. Results: Among 123 total AFMR patients, mean preoperative left atrial dimensions were enlarged to 4.9 (95% CI, 4.7-5.0) cm, whereas mean preoperative left ventricular diastolic dimensions remained near normal at 5.0 (95% CI, 4.9-5.2) cm. Preoperative atrial fibrillation was noted in 61% (74/123). Echocardiogram was performed in 58% (71/123) of patients at a median of 569 (interquartile range, 75-1782) days after surgery. Of those, 72% (51/71) had trivial or no MR, 22% (16/71) mild, and only 6% (4/71) moderate or greater MR. Only 1.6% (2/123) required redo mitral valve reoperation. Estimated 5-year survival was 74%. Conclusions: Patients with AFMR do well after mitral valve repair using an annuloplasty ring, with low rates of reoperation, mortality, and recurrence of MR. Mitral annuloplasty should be considered the surgical therapy of choice for AFMR. (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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