Effects of Atrial Fibrillation on Treatment of Mitral Regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) Randomized Trial

Mar 27, 2012
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Authors:
Herrmann HC, Gertz ZM, Silvestry FE, et al.
Citation:
J Am Coll Cardiol 2012;59:1312-1319.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does atrial fibrillation (AF) affect outcomes after mitral valve repair?

Methods:

This was a post-hoc analysis of a clinical trial in which 264 patients with severe mitral regurgitation (MR) were randomly assigned to MitraClip repair or surgical repair. Outcomes were compared between 72 patients with AF (27%, mean age 72 years) and 192 patients without AF (mean age, 64 years). The primary composite efficacy endpoint was freedom from death, surgery for mitral valve dysfunction, and from grade 3-4+ MR at 12 months.

Results:

Patients with AF more often had comorbidities such as heart failure, prior myocardial infarction, and chronic renal disease. AF was associated with a longer hospital stay in MitraClip patients (0.8 days) and in the surgical patients (3.0 days). There were no significant differences in major adverse events between patients with and without AF. There also was no significant difference in the composite efficacy endpoint between patients with AF (64%) and without AF (61%). The degree of MR reduction was greater with surgery than with MitraClip repair, but the degree of MR reduction was not affected by the presence of AF.

Conclusions:

Although AF is associated with older age and more comorbidities, its presence does not compromise the safety or efficacy of either MitraClip or surgical mitral valve repair.

Perspective:

As seen in this study, AF is common in patients with severe MR. Prior studies have disagreed on whether AF affects outcomes after surgical mitral valve repair or replacement. The results of the present study suggest that the only negative impact of AF on outcomes after mitral valve repair is prolongation of the length of hospitalization.

Keywords: Myocardial Infarction, Kidney Failure, Chronic, Mitral Valve Insufficiency, Heart Failure, Comorbidity, Cardiac Surgical Procedures, Mitral Valve, Renal Insufficiency, Chronic, Length of Stay


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