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Mitral annular disjunction in mitral valve prolapse with mitral regurgitation was tied to a threefold increase in long-term risk for postoperative arrhythmias.

Mitral annular disjunction (MAD) in patients with mitral valve prolapse (MVP) and mitral regurgitation (MR) was linked to a threefold increase in long-term risk for ventricular arrhythmias (VAs) after mitral valve surgery, despite MAD correction, according to a study published online in the European Heart Journal.

“To our knowledge, this study constitutes the hitherto largest cohort of mitral valve surgery patients featuring detailed echocardiographic characterization of MAD and complete long-term outcome tracking,” wrote corresponding author Bahira Shahim, MD, PhD, and study coauthors. The team reported, “Mitral annular disjunction was more common in women and was associated with Barlow’s disease, the need for mitral valve surgery for MR at a younger age, and a substantial increased long-term risk of VA, despite complete anatomical correction of pre-operative MAD.”

Methodology

The retrospective analysis included 599 patients with MVP and moderate to severe degenerative mitral regurgitation who underwent surgical mitral valve repair or replacement at Karolinska University Hospital from 2010 to 2022. True MAD length was measured at end‐systole by means of preoperative and postoperative transthoracic echocardiography.

The primary outcome comprised VAs—hospitalizations, outpatient visits, or ablation for confirmed sustained or nonsustained ventricular tachycardia, or a high burden of premature ventricular complexes—ascertained through review of medical records.

Characteristics & Outcomes

The authors reported that 96 patients (16%) exhibited preoperative MAD, with a median length of 8.0 mm (interquartile range [IQR], 5.0-10.0 mm). Compared with those without MAD, this group presented at a younger age (median, 55 vs 63 years), included more women (31% vs 17%), and demonstrated a higher prevalence of Barlow’s disease (70% vs 27%) and bileaflet prolapse (57% vs 17%).

All patients underwent surgical anatomical correction of MAD. Over a median follow‑up of 5.4 years (IQR, 2.8-7.5 years), preoperative MAD remained an independent predictor of VA (age‑ and sex‑adjusted hazard ratio, 3.33; 95% CI, 1.37-8.08), with no significant difference between repair and replacement, according to the study.

Novel Findings

The authors identified three novel findings: (1) patients with MAD presented for mitral valve surgery approximately 8 years earlier and faced nearly a threefold higher long-term risk for postoperative VAs, irrespective of repair versus replacement; (2) each additional millimeter of MAD length conferred a 35% greater risk for postoperative arrhythmias; and (3) surgical correction of MAD was achieved without increasing the likelihood of repair failure, repeat procedures, or residual MR compared with patients without MAD.

“These findings highlight the importance of close monitoring for MR progression among the subset of patients with MVP with MAD to offer a timely intervention,” the authors concluded.