Original article
Adult cardiac
Long-Term Outcomes of Maze Procedure Plus Valve Replacement in Treating Rheumatic Valve Disease Resulting in Atrial Fibrillation

https://doi.org/10.1016/j.athoracsur.2010.02.058Get rights and content

Background

This study aimed to analyze the long-term results of mitral valve replacement and concomitant Cox-Maze III procedure (CMP) in treating rheumatic heart valve disease and associated permanent atrial fibrillation. Outcomes of CMP using a pure “cut-and-sew” method were assessed.

Methods

Between 1995 and 2004, 60 patients received mechanical mitral (or mitral plus aortic) valve replacement and concomitant CMP. Among them, 22 underwent classic CMP that included five localized cryoablations, and 38 received a CMP without using cryoablations. All patients received periodic follow-up and oral anticoagulation therapy.

Results

The demographic features of both groups of patients were comparable. A total of 65 mechanic valves were implanted. Operative data and in-hospital outcomes were insignificant except that the immediate sinus conversion rate was higher in the pure cut-and-sew group. At last follow-up, sinus rhythm was 81.1% in the pure cut-and-sew group (median, 112 months) and 72.7% in the classic CMP group (median, 113 months; p = 0.4541). Actuarial freedom from atrial fibrillation was also similar (5 years, 83.8% versus 76.8%; 10 years, 79.1% versus 70.4%; p = 0.6039). In both groups, the late results of left atrium size were significantly reduced, while the proportion of long-term tricuspid regurgitation was still remarkable.

Conclusions

Mitral valve replacement and concomitant CMP is effective in treating rheumatic valve disease and permanent atrial fibrillation with satisfactory results. A complete cut-and-sew method is technically practicable, and is as effective as the classic CMP in the long term.

Section snippets

Study Population

From April 1995 to June 2004, 60 patients with RHVD and permanent AF referred for mitral (or mitral plus aortic) valve replacement were included in this study. The study was approved by the Investigational Review Board of Zhejiang University. All the cases validated informed consent from the patients or from their families. In terms of the study protocol, two types of concomitant CMP, either containing five localized cryoablations or using pure cut-and-sew, were performed according to a

Operative Data

Patients in the classic CMP group received 20 MVR and 2 mitral plus aortic valve replacements with 12 concomitant tricuspid annuloplasties and 3 extractions of left atrial thrombus. In the pure cut-and-sew group, 35 MVR and 3 mitral plus aortic valve replacements were performed with 23 tricuspid annuloplasties and 4 extractions of left atrial thrombus. Aortic cross-clamp and cardiopulmonary bypass times were insignificantly longer in the classic CMP group (Table 2).

Morbidity and Mortality

After the operations, 1

Comment

Atrial fibrillation occurs in as many as 50% of patients who undergo mitral valve surgery and is known to upset cardiac performance and prompts the risk of systemic emboli [12]. The Cox-Maze III procedure and concomitant valve surgery is recommended for patients with AF and associated mitral valve disease [13]. When performing CMP on patients with RHVD, particular considerations are required. On the one hand, these hearts have a substantial substrate for AF generation and continuation because

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