Atrial fibrillation and early clinical outcomes after mitral valve surgery in patients with rheumatic vs. non-rheumatic mitral stenosis

ABSTRACT

Atrial fibrillation [AF] is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis [MS] is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement [MVR] surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL [IgM, IgG], ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. The mean age of patients was 48.56 +/- 17.64 years. 57 cases [57%] were male, and 43 cases [43%] were female. Post-operative AF occurred in 14 cases [14%]; 3 cases [6%] in non-rheumatic mitral stenosis group, and 11 cases [22%] in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis [P = 0.02]. Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group [P = 0.026]. There was no relationship between the type of mitral stenosis [rheumatic or non-rheumatic] and early mortality after mitral valve replacement [P = 0.8]. We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement