Mid-term results of valve repairs for atrial functional mitral and tricuspid regurgitations

  • Yosuke TakahashiEmail author
  • Yukio Abe
  • Murakami Takashi
  • Hiromichi Fujii
  • Akimasa Morisaki
  • Shinsuke Nishimura
  • Yoshito Sakon
  • Kazato Ito
  • Ayumi Shintani
  • Toshihiko Shibata
Original Article



This study aimed to determine the mid-term outcomes of surgical valve repairs for atrial functional mitral regurgitation and tricuspid regurgitation in patients with atrial fibrillation.


From October 2008 to August 2016, we performed mitral and tricuspid valve repairs in 45 patients with permanent atrial fibrillation, chronic heart failure, preserved left ventricular ejection fraction, and at least moderate functional mitral regurgitation and mild functional tricuspid regurgitation. The follow-up period ranged from 56 to 3283 days (2–109 months; median 932 days).


All patients underwent both mitral and tricuspid annuloplasty. Mitral regurgitation and tricuspid regurgitation improved from 2.6 ± 0.6 (0–3) and 2.0 ± 0.7 (0–3) preoperatively to 0.4 ± 0.3 (0–3) and 0.8 ± 0.5 (0–3) at the most recent echocardiography (p < 0.0001 and p < 0.0001), respectively. Further, the New York Heart Association functional class dramatically improved from 2.8 ± 0.7 to 1.5 ± 0.7 (p < 0.0001). Postoperative cardiovascular events occurred in 10 patients, including 3 with re-admissions for heart failure. The event-free rates were 93%, 87%, and 52% at 1, 3, and 5 years after surgery, respectively. The preoperative left atrial volume index was the independent predictor of postoperative cardiovascular events.


Our results suggest that mitral and tricuspid valve repairs lead to reductions in regurgitations and heart failure symptoms in patients with atrial functional mitral and tricuspid regurgitations. The preoperative left atrial size should be recognized as an important risk factor of postoperative cardiovascular events.


Mitral valve repair Functional mitral regurgitation Tricuspid regurgitation Left atrium Atrial fibrillation 



This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA, et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation. 1990;82:792–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Otsuji Y, Kumanohoso T, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol. 2002;39:1651–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Zhou X, Otsuji Y, Yoshifuku S, Yuasa T, Zhang H, Takasaki K, et al. Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation. Circ J. 2002;66:913–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Ito K, Abe Y, Takahashi Y, Shimada Y, Fukumoto H, Matsumura Y, et al. Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: a study using three-dimensional transesophageal echocardiography. J Cardiol. 2017;70:584–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel RJ, et al. Functional tricuspid regurgitation caused by chronic atrial fibrillation: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging. 2017;10:e004897.CrossRefPubMedGoogle Scholar
  6. 6.
    Abe Y, Akamatsu K, Ito K, Matsumura Y, Shimeno K, Naruko T, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J. 2018;82:1451–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Takahashi Y, Abe Y, Sasaki Y, Bito Y, Morisaki A, Nishimura S, et al. Mitral valve repair for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. Interact Cardiovasc Thorac Surg. 2015;21:163–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Takahashi Y, Shibata T, Hattori K, Kato Y, Motoki M, Morisaki A, et al. Extended posterior leaflet extension for mitral regurgitation in giant left atrium. J Heart Valve Dis. 2014;23:88–90.PubMedGoogle Scholar
  9. 9.
    Shibata T, Inoue K, Ikuta T, Bito Y. A workbench to make artificial chordal loops for mitral valve repair. J Thorac Cardiovasc Surg. 2009;138:506–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Shibata T, Kato Y, Motoki M, Takahashi Y, Morisaki A, Nishimura S, et al. Mitral valve repair with loop technique via median sternotomy in 180 patients. Eur J Cardiothorac Surg. 2015;47:491–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–633.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefGoogle Scholar
  13. 13.
    Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Sumida T, Tanabe K, Yagi T, Kawai J, Konda T, Fujii Y, et al. Single-beat determination of Doppler-derived aortic flow measurement in patients with atrial fibrillation. J Am Soc Echocardiogr. 2003;16:712–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Shibata T. Loop technique for mitral valve repair. Gen Thorac Cardiovasc Surg. 2014;62:71–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sawazaki M, Tomari S, Tsunekawa T, Izawa N, Tateishi N. Aggressive atrial volume reduction for bilateral giant atria improves respiratory function. Ann Thorac Surg. 2013;95:1464–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Corciova FC, Corciova C, Georgescu CA, Enache M, Anghel D, Bartos O, et al. Echocardiographic predictors of adverse short-term outcomes after heart surgery in patients with mitral regurgitation and pulmonary hypertension. Heart Surg Forum. 2012;15:E127–E132132.CrossRefPubMedGoogle Scholar
  18. 18.
    Subbotina I, Girdauskas E, Bernhardt AM, Sinning C, Reichenspurner H, Sill B. Comparison of outcomes of tricuspid valve surgery in patients with reduced and normal right ventricular function. Thorac Cardiovasc Surg. 2017;65:617–25.CrossRefPubMedGoogle Scholar
  19. 19.
    Machino-Ohtsuka T, Seo Y, Ishizu T, Sato K, Sugano A, Yamamoto M, et al. Novel mechanistic insights into atrial functional mitral regurgitation-3-dimensional echocardiographic study. Circ J. 2016;80:2240–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Hashim SW, Youssef SJ, Ayyash B, Rousou AJ, Ragnarsson S, Collazo S, et al. Pseudoprolapse of the anterior leaflet in chronic ischemic mitral regurgitation: identification and repair. J Thorac Cardiovasc Surg. 2012;143:S33–S37.CrossRefPubMedGoogle Scholar
  21. 21.
    Berdejo J, Shiota M, Mihara H, Itabashi Y, Utsunomiya H, Shiota T. Vena contracta analysis by color Doppler three-dimensional transesophageal echocardiography shows geometrical differences between prolapse and pseudoprolapse in eccentric mitral regurgitation. Echocardiography. 2017;34:683–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Yosuke Takahashi
    • 1
    Email author
  • Yukio Abe
    • 2
  • Murakami Takashi
    • 1
  • Hiromichi Fujii
    • 1
  • Akimasa Morisaki
    • 1
  • Shinsuke Nishimura
    • 1
  • Yoshito Sakon
    • 1
  • Kazato Ito
    • 2
  • Ayumi Shintani
    • 3
  • Toshihiko Shibata
    • 1
  1. 1.Department of Cardiovascular SurgeryOsaka City University Graduate School of MedicineAbenokuJapan
  2. 2.Department of CardiologyOsaka City General HospitalOsakaJapan
  3. 3.Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan

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