Mitral valve repair and surgical ablation for atrial functional mitral regurgitation

Background: This observational study aimed to share our experience in the surgical management of atrial functional mitral regurgitation (AFMR). Methods: We retrospectively identified 82 AFMR patients (63.6 +/- 7.7 years) from June 2008 to November 2018 at our institution. Of these patients, 72.0% of them were classified as NYHA functional class III/IV, and all of them had persistent AF. All patients underwent mitral valve (MV) repair, and 52 (63.4%) received concomitant surgical ablation (SA). Patients were followed up for 26.1 +/- 27.6 months, and postoperative mitral regurgitation (MR) was assessed by echocardiography. Results: There was no in-hospital mortality. The overall 1-year and 3-year survival rates were 97.5% and 92.9%, respectively, and 96.1% of patients recovered to NYHA functional class I/II at the latest followup. The left atrium (LA) diameter (P<0.001), left ventricular (LV) end-diastolic diameter ( P<0.001), LV end-systolic diameter (LVESD) (P<0.001) and pulmonary artery pressure (P=0.006) significantly decreased postoperatively. The overall 1-year and 3-year freedom from recurrent MR rates were 94.3% and 65.3%, respectively, and a significant difference was found between the SA group and the non-SA group (93.8% and 93.8% vs. 95.5% and 44.2%, P=0.035). In a subgroup analysis, this significant difference was only found in the small LA group (<= 60 mm). Conclusions: Our results suggest that MV repair for AFMR is safe and effective. It improves heart failure symptoms and results in reverse-remodeling of both the LA and LV. Concomitant SA might benefit patients in terms of recurrent MR, especially in the small LA group (<= 60 mm).