Additional left atrial plication improves postoperative cardiovascular events in atrial functional mitral regurgitation.

BACKGROUND

Left atrial (LA) plication is a procedure used to correct an LA that expands posteriorly due to remodeling. This study aimed to determine the efficacy of additional LA plication in reducing postoperative cardiovascular events (CVEs) after mitral valve (MV) repair in atrial functional mitral regurgitation (MR) patients.

METHODS

Between October 2008 and August 2023, MV repair with or without LA plication in 74 patients was studied. This study examined the efficacy of concomitant LA plication during MV repair.

RESULTS

All patients underwent mitral annuloplasty. Of these, 26 underwent additional LA plication. In the mid-term periods, protruding posterior LA length in patients with LA plication was shorter than those without LA plication (2.8±0.49 . 3.3±0.72 cm, P=0.01). The percentage change in aortomitral angle from preoperative to mid-term periods in patients with LA plication was bigger than those without LA plication (1.04°±0.102° . 0.98°±0.084°, P=0.01). Posterior leaflet coaptation angle in patients with LA plication was smaller than those without LA plication (42°±15° . 76°±30°, P<0.001). A postoperative posterior leaflet coaptation angle of 101° had the maximum sum of sensitivity and specificity in predicting postoperative CVEs (96.9% and 76.9%, respectively). Patients with a postoperative posterior leaflet coaptation angle of 101° or higher had a poorer prognosis than those with an angle less than 101°, with an event-free rate of 18% . 80% at 7 years after surgery (P<0.0001).

CONCLUSIONS

Additional LA plication might be useful in reducing postoperative CVEs in atrial functional MR patients.