scholarly journals Rhythmic and haemodynamic determinants of long-term survival after radiofrequency ablation of atrial fibrillation in mitral valve surgery

2016 ◽  
Vol 2 (4) ◽  
pp. 285-290 ◽  
Author(s):  
Carlo Rostagno ◽  
Sandro Gelsomino ◽  
Pier Luigi Stefàno ◽  
Luigi Padeletti
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Term Survival ◽  
Long Term Survival

Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes

2021 ◽  
Author(s):  
Mark R Helmers ◽  
Max Shin ◽  
Amit Iyengar ◽  
Gabriel R Arguelles ◽  
Jarvis Mays ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Permanent Pacemaker ◽  
Valve Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Valvular Surgery

Abstract OBJECTIVES Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited. METHODS Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan–Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival. RESULTS A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12–1.35), concomitant aortic (1.44; 1.10–1.90) and tricuspid valve procedures (2.21; 1.64–2.97) and prior history of myocardial infarction (1.48; 1.07–1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19–8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality. CONCLUSIONS Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.

Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Eric Charbonneau ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

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