Is Atrial Fibrillation Resulting From Rheumatic Mitral Valve Disease a Proper Indication for the Maze Procedure?

Fukada, Johji; Morishita, Kiyofumi; Komatsu, Katsuya; Sato, Hiroki; Shiiku, Chikara; Muraki, Satoshi; Tsukamoto, Masaru; Abe, Tomio

doi:10.1016/s0003-4975(98)00135-0

Cited by 47 publications

(38 citation statements)

References 11 publications

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“…[21][22][23] Such an outcome appears to be quite consistent with the results of our study group, for which the conversion rate to normal sinus rhythm was 38.9% at the latest follow-up, a figure which was far lower than the results reported by others. [19][20][21] The higher atrial fibrillation recurrence rate for such rheumatic patients was assumed to derive from the occurrence of chronic pressure and/or volume overloading to the atrial wall or degeneration or inflammation of the atrial tissue, resulting in enlargement of the left atrium. Most previous studies described some risk factors for late failure of sinus rhythm restoration such as the presence of an enlarged left atrium, fine fibrillation wave size, and longer duration of Af in cases of atrial fibrillation concomitant with mitral surgery.…”

Section: Discussionsupporting

confidence: 93%

“…Most previous studies described some risk factors for late failure of sinus rhythm restoration such as the presence of an enlarged left atrium, fine fibrillation wave size, and longer duration of Af in cases of atrial fibrillation concomitant with mitral surgery. 20,22,24) On the basis of such results, in 1998, Fukada and associates 21) even went to the extent of suggesting that the indications for the maze procedure for Af associated with rheumatic mitral disease might need to be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

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Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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SUMMARYMitral repair is feasible for patients with degenerative or ischemic heart disease, however, the appropriateness of repair for rheumatic heart disease remains controversial. We compared our outcomes for primary isolated mitral repair versus replacement in an elderly population. From November 1997 to July 2005, mitral repair (group I) was performed in 33 patients while 59 underwent replacement (group II). Survival and risk factors were evaluated by Kaplan-Meier and Cox regression analysis. Mean age at operation for groups I and II was 49.7 ± 13.2 versus 58.1 ± 11.2 (P = 0.002). No statistically significant differences with regards to demographic parameters were observed except for there being fewer percutaneous transvenous mitral commissurotomy procedures and a lower severity of pulmonary hypertension in group I. Patients with a greater Wilkins score and more valvular calcification underwent replacement more often (P < 0.001). In-hospital mortality, ICU/hospital stay, and postoperative congestive heart failure functional class did not differ significantly. Major adverse cardiac events occurred in 13 and 19 patients, respectively (P = 0.50). There were 4 versus 6 late deaths (P = 0.74). Only two from group I underwent subsequent mitral reoperation. Kaplan-Meier overall survival and event-free survival at 5 years for groups I and II were 0.81 ± 0.08 versus 0.81 ± 0.06 (P = 0.90) and 0.52 ± 0.10 versus 0.51 ± 0.10 (P = 0.21), respectively. Old age, renal insufficiency, LVEF < 40%, and a history of stroke were poor predictors of patient survival. Compared with replacement, mitral repair for rheumatic heart disease was associated with a lower surgical mortality, higher repeat-surgery rate, and good survival. Rheumatic mitral valves should be repaired in select patients with appropriate valvular pathology. (Int Heart J 2008; 49: 565-576)

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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“…12) Fukada also suggested that fibrosis of the atrial myocardium caused by a long duration of AF and rheumatic inflammation might contribute to a poor outcome of the maze procedure. 13) In our series, 5 patients needed [14][15][16][17] which were also confirmed in this study. Although AF can be treated by the left-sided maze procedure, there is an increased risk of initiating atrial flutter, which is usually of right atrial origin.…”

Section: Discussionsupporting

confidence: 85%

Cryosurgical Left-sided Maze Procedure in Patients with Valvular Heart Disease: Medium-term Results

Sakamoto

Takakura

Onoguchi

et al. 2011

ATCS

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Purpose: We evaluated medium-term results of the left-sided maze procedure using cryoablation in patients with valvular heart disease. Methods: We retrospectively evaluated 111 patients with valvular heart disease who underwent the cryosurgical left-sided maze procedure. The mean follow-up period was 36.8 ± 24.9 months, and the mean duration of atrial fibrillation was 5.6 ± 6.0 years. The primary surgical procedure was mitral valve replacement in 42 patients, mitral valve plasty in 28, aortic valve replacement in 25, and combined aortic and mitral replacement or plasty in 16. Results: The 7-year actuarial survival rate was 82.9 ± 11.4% for patients in sinus rhythm and 87.0 ± 7.0% for patients with atrial fibrillation, showing no difference between the two groups (p = 0.236). At final follow-up, 86 out of 111 patients (77.5%) remained free from atrial fibrillation. Sinus rhythm was maintained in 26 of 42 patients (61.9%) in the mitral valve replacement group, 26 of 28 patients (92.9%) in the mitral valve plasty group, 15 of 17 patients (88.2%) in the aortic valve replacement group, and 18 of 24 patients (75.0%) in the combined aortic and mitral replacement or plasty group. The overall actuarial rate of freedom from atrial fibrillation at 5 years after surgery was 70.4 ± 6.0%. Conclusion: The cryosurgical left-sided maze procedure is a safe, simple, and excellent operation for medically refractory atrial fibrillation.

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“…The left atrial contractility determined as the peak velocity of the atrial filling wave to peak velocity of early filling wave ratio for the LA in the rheumatic group was significantly reduced compared with that in the nonrheumatic group [3]. On the contrary, others including our group demonstrated equally effective results, even though those were short-term outcomes [4,5].…”

Section: Introductionmentioning

confidence: 55%

Left Atrial and Left Ventricular Diastolic Function After the Maze Procedure for Atrial Fibrillation in Mitral Valve Disease: Degenerative Versus Rheumatic

Kim

Moon

et al. 2012

Indian J Surg

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The present study was aimed to compare the left atrial and left ventricular diastolic functions amongst the rheumatic and degenerative mitral valve disease patients in atrial fibrillation who reverted to normal sinus rhythm following Cox-maze procedure. We prospectively investigated the left atrial and left ventricular function with Doppler echocardiography, by dividing into the rheumatic (N = 105) and the degenerative group (N = 47). Over the follow-up period (mean: 4.4 ± 1.2 years in the rheumatic group, 4.8 ± 1.3 years in the degenerative group), the rheumatic group showed statistically significant decrease in A' velocity and E' velocity, on contrary to degenerative group (A' velocity: mean decrease of 0.43 ± 0.13 cm/s in the rheumatic group, mean increase of 0.57 ± 0.11 cm/s in the degenerative group, p = 0.029, E' velocity: mean decrease of 0.23 ± 0.17 cm/s in the rheumatic group, mean increase of 0.21 ± 0.15 cm/s in the degenerative group, p = 0.031). In addition, the rheumatic group showed statistically significant increase in E/E' ratio than the degenerative group (mean increase of 4.49 ± 1.98 in the rheumatic group, mean increase of 1.74 ± 1.52 in the degenerative group, p = 0.047). Despite successful sinus rhythm restoration, the progressive loss of LA function as well as LV diastolic function is more prominent in the rheumatic group than the degenerative group. Therefore, differentiated strategies for postoperative surveillance are needed according to the pathology of mitral valve disease.

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Is Atrial Fibrillation Resulting From Rheumatic Mitral Valve Disease a Proper Indication for the Maze Procedure?

Cited by 47 publications

References 11 publications

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Cryosurgical Left-sided Maze Procedure in Patients with Valvular Heart Disease: Medium-term Results

Left Atrial and Left Ventricular Diastolic Function After the Maze Procedure for Atrial Fibrillation in Mitral Valve Disease: Degenerative Versus Rheumatic

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