Time-Dependent Associations of Structural and Electrical Failure with Survival after Mitral Valve Repair and Concomitant Atrial Fibrillation Ablation for Degenerative Mitral Valve Disease: A Single-Center Retrospective Cohort Study in South Korea.

Authors

Jeesoo Lee, Kitae Kim, Hong Rae Kim, Ho Jin Kim, Jae Suk Yoo, Sung-Ho Jung, Joon Bum Kim

Published in

Journal of chest surgery. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

We examined associations of structural and electrical failure with long-term survival after mitral repair with atrial fibrillation (AF) ablation for degenerative mitral prolapse, using time-dependent modeling.
We analyzed 300 consecutive patients (age, 59.4±11.9 years; 34.7% female) undergoing degenerative mitral prolapse repair with surgical ablation. Structural failure was defined as postoperative severe mitral regurgitation (MR); electrical failure was defined as AF recurrence beyond a 3-month blanking period. Structural and electrical failures were modeled as time-varying covariates in Cox proportional hazards models evaluating mortality. Bidirectional time-dependent and landmark analyses assessed temporal interdependence.
During follow-up (median, 6.3 years), structural and electrical failures occurred at 4.1% and 5.7% per patient-year, respectively; death occurred at 1.1%/patient-year. Structural failure was independently associated with tricuspid regurgitation (TR) velocity (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.79-4.83) and anterior leaflet prolapse (aHR, 3.10; 95% CI, 1.18-8.12). Electrical failure was independently associated with age (aHR, 1.53; 95% CI, 1.19-1.98), left atrial diameter (aHR, 1.06; 95% CI, 1.04-1.08), and severe TR (aHR, 6.24; 95% CI, 2.15-18.11). In the time-dependent analysis, severe MR independently predicted mortality (aHR, 2.54; 95% CI, 1.01-6.38), whereas AF recurrence did not (aHR, 0.97; 95% CI, 0.24-3.97). Bidirectional analyses showed no significant temporal association between structural and electrical failures.
Among patients with degenerative mitral prolapse undergoing mitral repair with concomitant AF ablation, structural valve failure, but not electrical recurrence, was associated with increased long-term mortality. Structural and electrical failures showed no significant temporal association.

PMID:
42581509
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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