Is Mitral Annuloplasty an Effective Treatment for Severe Atrial Functional MR?

Atrial MR group Inclusion criteria * Adult patients, underwent mitral annuloplasty for atrial functional mitral Anatomical criteria * Annular dilatation with anterior-posterior diameter (AP) in systole \>35mm * Ratio of AP diameter in systole to anterior leaflet length in diastole \>1.3 * Normal leaflets anatomy * Mild fibrosis may be present * A small cleft may be present as a result of annular dilatation Functional criteria * Normal leaflet mobility (Carpentier type I) * Coaptation depth \<10mm * Absence of ventricular tethering * Centrality of the regurgitant jet Atrial and ventricular characteristics * Left atrium diameter \> 40 mm * Normal systolic function of the left ventricle * Mild left ventricular systolic dysfunction Mild LV (tachycardia induced) with EF \>45% * Absence of regional abnormalities in left ventricular wall motion Clinical criteria * Persistent, long-standing persistent, or permanent atrial fibrillation Exclusion criteria * Degenerative MR including congenital clefts * LVEF \< 45% * Ventricular tethering * Coaptation depth \>10 mm * Regional abnormalities in left ventricular wall motion * Sinus rhythm * Presence of coronary artery disease * Absence of annular dilatation Non-atrial MR group Inclusion criteria * Adult patients underwent cardiac surgery for non-atrial functional mitral regurgitation in the setting of an idiopathic or ischemic cardiomyopathy Exclusion criteria * FE\<40% * Concomitant coronary artery bypass graft * Age \<65 years and \>75years * Treated with annuloplasty + edge-to-edge surgery * Sinus rhythm