Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
J Cardiothorac Surg. 2024 Jul 10;19(1):433. doi: 10.1186/s13019-024-02858-w.
Atrial functional mitral regurgitation (AFMR) is a newly discovered condition associated with longstanding atrial fibrillation. This retrospective study aimed to analyze the outcomes of the maze procedure and mitral regurgitation (MR) surgery in AFMR and atrial fibrillation in comparison with those in degenerative MR (DMR).
Patients who underwent mitral valve repair/replacement with a maze procedure at a hospital (July 2012-August 2021) were included. We excluded patients aged below 18 years undergoing concomitant coronary artery bypass grafting or atrial septal defect repair and those with MR etiology other than ARMR or DMR.
We included 35 patients with AFMR and 50 patients with DMR. Patient characteristics and postoperative outcomes were not significantly different between the two groups. Long-term outcomes revealed no significant differences in the ratio of cardiac mortality, stroke, or hospital readmission. However, after the maze procedure, the sinus rhythm restoration rate was significantly lower (62% vs. 28.5%, p < 0.001), a junctional rhythm state (p < 0.001) and permanent pacemaker insertion for sick sinus syndrome (SSS) (p = 0.03) were significantly more common in AFMR than DMR. On postoperative transthoracic echocardiography (TTE), the pulmonary artery systolic pressure was significantly less decreased in the AFMR group than in the DMR group compared with that on preoperative TTE (p = 0.04).
AFMR showed excellent mitral valve surgery outcomes, similar to DMR, but had a significantly higher risk of pacemaker insertion for SSS after the maze procedure.
心房功能性二尖瓣反流（AFMR）是一种与长期持续性心房颤动相关的新发现的病症。本回顾性研究旨在分析迷宫手术和二尖瓣修复/置换术治疗 AFMR 和心房颤动的结果，并与退行性二尖瓣反流（DMR）的结果进行比较。
纳入在医院接受二尖瓣修复/置换术并同时行迷宫手术的患者（2012 年 7 月至 2021 年 8 月）。排除年龄小于 18 岁且同时行冠状动脉旁路移植术或房间隔缺损修补术的患者，以及二尖瓣反流病因非 ARMR 或 DMR 的患者。
共纳入 35 例 AFMR 患者和 50 例 DMR 患者。两组患者的特征和术后结果无显著差异。长期结果显示，两组在心脏死亡率、卒中和再住院率方面无显著差异。然而，在迷宫手术后，窦性节律恢复率显著降低（62% vs. 28.5%，p<0.001），交界性节律状态（p<0.001）和因病态窦房结综合征而植入永久性起搏器（p=0.03）的发生率在 AFMR 组明显高于 DMR 组。术后经胸超声心动图（TTE）检查显示，与术前 TTE 相比，AFMR 组肺动脉收缩压的降低幅度明显小于 DMR 组（p=0.04）。
AFMR 组二尖瓣手术结果与 DMR 相似，但迷宫手术后病态窦房结综合征的起搏器植入风险明显更高。
