Mitral Valve Regurgitation Secondary to Atrial Fibrillation: Results of Annuloplasty Only Repair

Background: Information regarding the durability of severe mitral valve (MV) regurgitation (MR) repair in patients with normal MV leaflets, normal subvalvular apparatus, and dilated annulus due to atrial fibrillation (AF) is lacking. We report on outcomes of ring-only repair (ROR) in severe MR secondary to AF.

Methods: Between 2004 and 2020, we detected 64 patients with severe MR due to AF who underwent ROR in our department. The main outcome measure of this study was long-term recurrent MR probability. Secondary outcomes were late mortality, reoperation, and in-hospital complications.

Results: Mean age was 66±13 years, 60% were males and 17% had previous operation. The mean ejection fraction was 49±11%, the mean left atrial area was 34±9 cm2, left atrial diameter was 5±1cm and left atrial volume was 141±60 ml. All patients underwent a ROR with a mean annuloplasty size of 30.1±2.6mm. Concomitant MAZE procedure was performed in 38% and tricuspid repair in 44%. There were no cases of in-hospital or 30-day mortality in the entire cohort. Post-repair outflow tract obstruction (SAM) was not observed in any patient after ROR. Two patients (3.1%) required re-exploration for bleeding, none had postoperative stroke (0%), two (3.1%) required permanent pacemaker implantation, and one patient had deep sternal wound infection (1.6%). During a mean follow-up of 72±48 months, there were 7 patients who died (10.9%). Most patients were in good functional capacity with NYHA functional class I-II in 89.1%, none required reoperation on the MV due to recurrence, and only 2 patients (3.6%) had recurrent severe MR at the latest follow-up. The only predictor for recurrent MR was the presence of a permanent pacemaker (HR 23.1 95%CI 4.39-121.5, p<0.001).

Conclusion: In patients with severe MR secondary to AF, ROR is a simple and efficient approach providing excellent long-term results.