Influence of atrial fibrillation on outcome following mitral valve repair

Background-To investigate the outcome of patients in atrial fibrillation (A F) following mitral valve repair, clinical and echocardiographic follow-up was undertaken in 400 consecutive patients who underwent mitral valvuloplas ty from 1987 to 1999. Methods and Results-The main indications for surgery were degenerative (81. 4%), endocarditis (7.1%), rheumatic (6.6%), ischemic (4.6%), and traumatic (0.3%) mitral valve disease. After excluding 6 paced patients and I patient in nodal rhythm, we compared the outcomes of 152 patients in AF against 24 1 patients in sinus rhythm. For patients in AF versus those in sinus rhythm , more AF patients were older (mean age 67.2 +/-8.8 versus 61.9 +/- 11.8 ye ars, respectively, P <0.001), more were assigned to a poorer New York Heart Association (NYHA) class (77.6% versus 66.0% in NYHA III/IV. respectively; P=0.01), and more demonstrated impaired ventricular function (78.9% versus 46.2% with moderate or severe impairment, respectively; P <0.001). For pat ients in AF versus those in sinus rhythm. there was no difference in 30-day mortality (2.0% versus 2.1%, respectively; P=0.95), repair failure (5.4% v ersus 3.6%, respectively; P=0.41), stroke (5.4% versus 2.2%, respectively; P=0.11), or endocarditis (2.3% versus 0.9%, respectively; P=0.27) on follow -up at a median of 2.8 years (interquartile range 1.1 to 6.0). On echocardi ography, the proportion of patients with mild regurgitation or worse was 13 .3% (AF patients) versus 10.8% (patients in sinus rhythm) (P=0.70). Patient s in AF versus those in sinus rhythm had lower survival at 3 years (83% ver sus 93%, respectively) and 5 years (73% versus 88%, respectively). Univaria te analysis identified factors affecting survival as AF (P=0.002), age > 70 years (P=0.041), and poor ventricular function (P <0.001), However, by use of a multivariate model, only poor ventricular function remained significa nt (P=0.01). Conclusions-AF does not affect early outcome or durability of mitral repair . The onset of AF may be indicative of disease progression because of its a ssociation with poor left ventricular function.