Surgical Strategy for Atrial Functional Mitral Regurgitation With Atrial Fibrillation

Abstract

BACKGROUND: Atrial functional mitral regurgitation (AFMR) combined with atrial fibrillation (AF) has become a significant clinical challenge. This study evaluates surgical treatment strategies based on the degree of MR and rhythm control therapy for patients with AFMR and AF. METHODS: This retrospective study included 145 patients with AF and MR from January 2017 to January 2023. Patients were grouped as follows: moderate atrial regurgitation (n=33), severe atrial regurgitation (SAR, n=56), and severe primary regurgitation (SPR, n=56). The group with moderate atrial regurgitation underwent thoracoscopic AF procedure with a unilateral approach, and the SAR and SPR groups received mitral valvuloplasty plus the Cox-Maze IV procedure. Descriptive characteristics and treatment outcomes were analyzed. RESULTS: At an average follow-up of 2.6±1.1 years, 23 patients in the group with moderate atrial regurgitation maintained sinus rhythm. MR improved in 26 patients, remained unchanged in 6 patients, and worsened in 1 patient. Sinus rhythm maintenance was associated with MR reduction (P=0.0002). The rate of sinus rhythm maintenance in the groups with SAR and SPR was similar (SAR 79.6%, SPR 87.5%). Echocardiography in the group with SAR showed 47 patients with no MR, 4 with mild MR, and 1 with moderate MR. The left atrial diameter in the group with SAR remained larger than in the group with SPR (P<0.001). CONCLUSIONS: Rhythm control therapy is essential for treating AFMR with AF. The thoracoscopic AF procedure is effective and minimally invasive for moderate AFMR. For severe AFMR, Cox-Maze IV combined with mitral valvuloplasty provides optimal safety and effectiveness.