Shin Jung-Hoon, Lee Seung-Hyun, Joo Hyun-Chul, Youn Young-Nam, Kim Jung-Hwan, Lee Sak
Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Ann Thorac Surg. 2025 Jul;120(1):71-78. doi: 10.1016/j.athoracsur.2024.09.001. Epub 2024 Sep 12.
Atrial functional mitral regurgitation (AFMR), defined by normal left ventricular function, enlarged left atrium, and a dilated mitral valve annulus, has been a concept discussed for >10 years. However, there are still no established guidelines for its treatment in the American College of Cardiology/American Heart Association recommendations. This study aimed to determine the long-term outcomes of mitral annuloplasty as a treatment for AFMR.
We analyzed 1435 patients who underwent mitral valve repair at our institution between 2005 and 2020, with 162 classified as having AFMR. Exclusion criteria for AFMR were established based on preoperative echocardiography and operative notes. The primary outcome was overall mortality, and the secondary outcome was MR recurrence, which was defined as moderate or greater mitral regurgitation observed on echocardiography during the follow-up period, analyzed using our hospital's medical records and data from the National Statistical Office.
The median follow-up duration for the entire patient cohort was 6.1 years (interquartile range, 3.2-11.2 years). Patients had a 5-year survival rate of 86% and a 10-year survival rate of 73%, with freedom from MR recurrence rates of 89% and 80% at 5 and 10 years, respectively. Although all 162 patients had moderate or greater MR before surgery, most experienced trivial or mild MR after mitral valve repair throughout the follow-up period.
In summary, mitral valve repair effectively treats patients with AFMR, addressing survival and mitigating MR recurrence.
心房功能性二尖瓣反流（AFMR）定义为左心室功能正常、左心房扩大和二尖瓣环扩张，这一概念已被讨论了10多年。然而，在美国心脏病学会/美国心脏协会的指南中，仍没有针对其治疗的既定准则。本研究旨在确定二尖瓣环成形术治疗AFMR的长期疗效。
我们分析了2005年至2020年间在我院接受二尖瓣修复术的1435例患者，其中162例被归类为患有AFMR。AFMR的排除标准是根据术前超声心动图和手术记录确定的。主要结局是全因死亡率，次要结局是二尖瓣反流复发，定义为随访期间超声心动图观察到的中度或更严重的二尖瓣反流，使用我院的病历和国家统计局的数据进行分析。
整个患者队列的中位随访时间为6.1年（四分位间距，3.2 - 11.2年）。患者的5年生存率为86%，10年生存率为73%，5年和10年无二尖瓣反流复发率分别为89%和80%。尽管所有162例患者术前均有中度或更严重的二尖瓣反流，但在整个随访期间，大多数患者在二尖瓣修复术后出现轻微或轻度二尖瓣反流。
总之，二尖瓣修复术能有效治疗AFMR患者，改善生存情况并减少二尖瓣反流复发。
