Efficacy of surgical valve surgery for end stage atrial fibrillation: a report of 693 cases

Abstract

Objective To summarize the mid- and long-term curative efficacy of surgical valve surgery intervention for the patients with end-stage atrial fibrillation by analyzing the main points of clinical and ultrasonic diagnosis. Methods Clinical data of 693 patients with atrial fibrillation diagnosed by echocardiography admitted to our General Hospital of Northern Theater Command from January 2012 to June 2019 were collected and retrospectively analyzed. According to the regurgitation of atrioventricular valve, they were divided into Group A (slight or mild mitral and/or tricuspid insufficiency), Group B (moderate or above tricuspid insufficiency), Group C (moderate or above mitral insufficiency), and Group D (moderate or above mitral and tricuspid insufficiency). There were total 505 patients in the latter 3 groups, among which 124 underwent heart valve surgery. Results The severiry of atrioventricular valve regurgitation was constantly changing in the 693 patients. There were 65 patients with reduced reflux after medical treatment, and 23 of them underwent radiofrequency ablation of atrial fibrillation. Atrioventricular regurgitation was aggravated in 505 patients. Among the patients with moderate severe regurgitation, the non-operation patients had significantly longer history of atrial fibrillation, larger left ventricular diameter, and lower left ventricular systolic and diastolic functions than the operation patietns (P < 0.05). The 124 patients underwent surgical treatment, but 1 patient died during perioperative period, and the others were followed up from 6 months to 94 months (averagely 63.03 months, 54.61 to 71.44 months). Paired analysis showed that suegical treatment resulted in significantly decreased diameter of each atrium (P < 0.001), improved cardiac function classification (P < 0.001), and reduced score of Self-rating Anxiety Scale (SAS, P < 0.001). Although some patients (24 cases) had lower LVEF after operation, there was no significant difference (P=0.067). The sinus rhythm was restored and maintained in 14 (87.5%) of 16 patients who underwent valve surgery at the same time, and 18 (16.8%) of 107 patients underwent valve surgery alone. Conclusion Surgical valve surgery should be carried out actively for the patients with end-stage atrial fibrillation with massive atrioventricular valve regurgitation, with the advantages of low risk and good quality of life.

Keywords

• atrial fibrillation
• atrial functional atrioventricular valve regurgitation
• valve surgery
• echocardiography
• survival analysis