Patients

From April 2008 to November 2021, we performed mitral valve repair with PA in 16 patients who had AFMR with a tethered posterior leaflet and severe left atrial enlargement due to long-standing atrial fibrillation at Osaka Metropolitan University Hospital and Osaka City General Hospital. Additionally, we performed mitral VR for AFMR with a tethered posterior leaflet and severe left atrial enlargement due to long-standing atrial fibrillation in 23 patients between April 2012 and November 2021 at Osaka Metropolitan University Hospital. The patients who had congestive heart failure caused by AFMR and long-standing atrial fibrillation even after medical management, including rhythm control, were eligible for inclusion in the study. We excluded patients with a reduced left ventricular (LV) ejection fraction (LVEF) (<50%) because decreased LV function may be associated with other cardiac diseases. Finally, we compared the outcomes of PA (n=16; PA group) with those of VR (n=15; VR group) for AFMR with a tethered posterior leaflet and severe atrial enlargement due to long-standing atrial fibrillation. We defined AFMR with a tethered posterior leaflet as severe shortening and tethering of the posterior leaflet and mitral annular dilatation with or without pseudo-prolapse of the anterior leaflets in accordance with the guidelines of the Japanese Circulation Society (5). Preoperative comorbidities and perioperative complications were defined by referring to the Japan Cardiovascular Surgery Database (http://www.jacvsd.umin.jp). Major adverse cardiac events after hospital discharge included cardiac death, readmission for congestive heart failure, cardiac thromboembolic events, and cardiac reoperation.