Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance

Jan Stassen; Aniek L van Wijngaarden; Hoi W Wu; Meindert Palmen; Anton Tomsic; Victoria Delgado; Jeroen J Bax; Nina Ajmone Marsan

doi:10.3390/jcdd9070230

Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance

J Cardiovasc Dev Dis. 2022 Jul 18;9(7):230. doi: 10.3390/jcdd9070230.

Authors

Jan Stassen^{1

2}, Aniek L van Wijngaarden¹, Hoi W Wu¹, Meindert Palmen³, Anton Tomsic³, Victoria Delgado¹, Jeroen J Bax^{1

4}, Nina Ajmone Marsan¹

Affiliations

¹ Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
² Department of Cardiology, Jessa Hospital, 3500 Hasselt, Belgium.
³ Department of Thoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
⁴ Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, 20521 Turku, Finland.

Abstract

Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir strain (LASr) were evaluated immediately before and after surgery, and during long-term follow-up in 226 patients undergoing mitral valve repair for primary MR (age 62 ± 13 years, 66% male). Mean LAVi was reduced significantly after surgery and at long-term follow-up (from 56 ± 28 to 38 ± 21 to 32 ± 17 mL/m2; p < 0.001). LASr reduced significantly after surgery but increased again during the long-term (from 23.6 ± 9.4 to 11.5 ± 5.0 to 17.3 ± 7.5%; p < 0.001). Age, pre-operative LAVi, MR severity, and postoperative transmitral pressure gradient were associated with LA reverse remodeling by the long-term check-up. During a median follow-up of 72 (40−114) months, 43 (19%) patients died. Patients with LAVi ≥ 42 mL/m2 at long-term follow-up showed significant higher mortality rates compared to patients with LAVI < 42 mL/m2 (p < 0.001), even after adjusting for clinical covariates. In conclusion, significant LA reverse remodeling was observed both immediately and at long-term follow-up after mitral valve repair. LA dilatation at long term follow-up after surgery was still associated with all-cause mortality.

Keywords: left atrial remodeling; left atrium volume index; mitral valve repair; mortality; primary mitral regurgitation.

Grants and funding

The department of Cardiology of the Leiden University Medical Centre received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Jeroen J Bax received speaker fees from Abbott Vascular. Nina Ajmone Marsan received speaker fees from Abbott Vascular and GE Healthcare. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, MSD, and GE Healthcare. Jan Stassen received funding from the European Society of Cardiology (ESC Training Grant App000064741). The remaining authors have nothing to disclose.