Long-Term Outcomes of Mechanical Valve Replacement in Patients With Atrial Fibrillation

Abstract

Background— The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear. Methods and Results— We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation–associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65–2.03; P =0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50–1.34; P =0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12–0.73; P =0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2–149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0–3) subgroup ( P =0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup ( P =0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular ( P <0.001) and tricuspid valvular functions ( P <0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0–146.8 months) after surgery. Conclusion— Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.

Differential Clinical Characteristics and Prognosis of Patients with Longstanding Persistent Atrial Fibrillation Presenting with Recurrent Atrial Tachycardia versus Recurrent Atrial Fibrillation After First Ablation

“…Thus, it is suggested that the next ablation strategy should take into account the above-mentioned determinants and include changes such as ablation transforming from LA to RA for patients undergoing ≥2 procedures and with concurrent RA enlargement, and concomitant treatment of MR and LS-AF by surgical ablation for patients with moderate or worse MR because of an ideal rate of SR obtained by Maze surgery. 14,15 In previous studies, 16,17 ATs that are inducible after LS-AF termination do not necessarily become clinical AT, and the distinguishing organized atrial arrhythmias from AF do not yield any further prognostic information. However, the major mechanism of clinical R-ATs during long-term follow-up is macroreentry, 2,4,7 which is in accord with our study.…”

Long‐Term Outcome Following Ablation of Atrial Tachycardias Occurring after Mitral Valve Replacement in Patients with Rheumatic Heart Disease

“…Because of a higher incidence of AF and left AT postmitral valve replacements, prophylactic maneuvers are strongly recommended in RHD patients with an AF history before surgery. The Maze procedure 29 for persistent AF patients and surgical PVAI might be undertaken when performing a valve replacement in a patient with or without paroxysmal AF.…”

Expert consensus guidelines: Examining surgical ablation for atrial fibrillation

“…A total of 905 studies were identified from the original PubMed search, of which 300 were reviewed in depth for inclusion, and 38 studies ultimately met all inclusion criteria. [10][11][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]40,42,[48][49][50][51][52][53][54][55][56][57] The remaining 262 studies were excluded because of no comparison group (n ¼ 245), case report (n ¼ 7), no outcome (n ¼ 6), or duplicate data from the same investigators (n ¼ 4).…”