PMID- 11568031
OWN - NLM
STAT- MEDLINE
DCOM- 20011004
LR  - 20220311
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 104
IP  - 12 Suppl 1
DP  - 2001 Sep 18
TI  - Influence of atrial fibrillation on outcome following mitral valve repair.
PG  - I59-63
AB  - BACKGROUND: To investigate the outcome of patients in atrial fibrillation (AF) 
      following mitral valve repair, clinical and echocardiographic follow-up was 
      undertaken in 400 consecutive patients who underwent mitral valvuloplasty 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 1 
      patient in nodal rhythm, we compared the outcomes of 152 patients in AF against 
      241 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 years, 
      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 patients 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% versus 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 echocardiography, the proportion of patients with mild 
      regurgitation or worse was 13.3% (AF patients) versus 10.8% (patients in sinus 
      rhythm) (P=0.70). Patients in AF versus those in sinus rhythm had lower survival 
      at 3 years (83% versus 93%, respectively) and 5 years (73% versus 88%, 
      respectively). Univariate 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 
      significant (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 association with poor left ventricular function.
FAU - Lim, E
AU  - Lim E
AD  - Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, and 
      the Medical Research Council Biostatistics Unit, Institute of Public Health, 
      Cambridge, UK.
FAU - Barlow, C W
AU  - Barlow CW
FAU - Hosseinpour, A R
AU  - Hosseinpour AR
FAU - Wisbey, C
AU  - Wisbey C
FAU - Wilson, K
AU  - Wilson K
FAU - Pidgeon, W
AU  - Pidgeon W
FAU - Charman, S
AU  - Charman S
FAU - Barlow, J B
AU  - Barlow JB
FAU - Wells, F C
AU  - Wells FC
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*complications/diagnosis
MH  - Demography
MH  - Disease Progression
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*complications/*surgery
MH  - Survival Analysis
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications/diagnosis
EDAT- 2001/09/25 10:00
MHDA- 2001/10/05 10:01
CRDT- 2001/09/25 10:00
PHST- 2001/09/25 10:00 [pubmed]
PHST- 2001/10/05 10:01 [medline]
PHST- 2001/09/25 10:00 [entrez]
AID - 10.1161/hc37t1.094813 [doi]
PST - ppublish
SO  - Circulation. 2001 Sep 18;104(12 Suppl 1):I59-63. doi: 10.1161/hc37t1.094813.