The impact of mitral valve surgery combined with maze procedure☆

Itoh, Akinobu; Kobayashi, Junjiro; Bando, Ko; Niwaya, Kazuo; Tagusari, Osamu; Nakajima, Hiroyuki; Komori, Shigeru; Kitamura, Soichiro

doi:10.1016/j.ejcts.2006.03.028

Cited by 61 publications

(50 citation statements)

References 27 publications

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“…Earlier studies have detected various such factors, including old age, larger left atrial diameter, a long preoperative history of arrhythmia, lower amplitude of F wave, rheumatic mitral valve disease, permanent AF, and maze-lesion sets. [18][19][20][21][22] In our study, only arrhythmia duration longer than 36 months was confirmed as an adverse variable; other issues emerged unexpectedly, and their significant role was corroborated by multiple statistical tools that we also used to evaluate the intrinsic nature of the arrhythmia (that is, its chance of recurring several times). 17 First, we conf irmed the importance of discharge rhythm, as was pointed out by Lazopoulos and colleagues 15 ; the consequent clinical application consists in prompt cardioversion of every tachyarrhythmia.…”

Section: Months After Maze Proceduresmentioning

confidence: 81%

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Loardi

Alamanni

Veglia

et al. 2015

Texas Heart Institute Journal

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The radiofrequency maze procedure achieves sinus rhythm in 45%-95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze-performed concomitant to elective cardiac surgery-to determine sinus-rhythm predictive factors, and describes the evolution of patients ' echocardiographic variables. From 2003' echocardiographic variables. From through 2011 A trial fibrillation (AF), the most common cardiac arrhythmia, increases morbidity and mortality rates in adults after cardiac surgery, 1 reaching a peak incidence in mitral-valve patients of 60% to 80%.2 According to several different clinical trials, 3-6 maze surgery by the cut-and-sew technique-or by alternative means of electrical blockage through the creation of linear lesions-results in sinus rhythm in 44% to 95% of patients. Its advantages consist of better survival rate and quality of life. 7,8 Although the maze procedure and its modifications have been performed since 1987, some issues remain unsolved. For example, it is uncertain how to identify features that can help in detecting patients who can truly benefit from this procedure as an adjunct to elective cardiac surgery. Moreover, whether its clinical gain is secondary, at least in part, to a favorable evolution of the dimensions and function of the cardiac chambers is still to be determined.This report of midterm follow-up of the radiofrequency maze procedure performed concomitant to elective cardiac surgery focuses upon the negative predictive role on arrhythmia recurrence played by the presence of AF at hospital discharge and, more unexpectedly, upon the positive effect of monopolar device use. It also describes the progression of patients' echocardiographic values. Patients and MethodsWe retrospectively analyzed 247 consecutive patients with structural heart disease and atrial fibrillation who were scheduled for cardiac surgery and a concomitant modi-

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Section: Months After Maze Proceduresmentioning

confidence: 81%

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Loardi

Alamanni

Veglia

et al. 2015

Texas Heart Institute Journal

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“…Although the surgical results of the maze procedure for cases of atrial fibrillation concomitant with mitral diseases have been shown to be excellent, 19,20) the results for maze treatment of atrial fibrillation associated with rheumatic mitral disease have been reported to be somewhat less effective. [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.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…[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: 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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“…Dieser Anteil sank nach 15 Jahre langsam auf 40%. Ob eine postoperative Konversion in einen normalen Sinusrhythmus die Überlebenschancen tatsächlich verbessert, scheint auf Grund von Literaturangaben unwahrscheinlich; vorläu-fig ebenfalls nicht schlüssig zu beantworten ist, ob eine Vorhofsprozedur den normalen Sinusrhythmus postoperativ auch längerfristig stabilisiert und sich lebensverlängernd auswirkt [22][23][24][25][26].…”

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Chirurgie der degenerativen Mitralinsuffizienz auch beim asymptomatischen Patienten?

2007

Schweiz Ärzteztg

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SummaryIt is well known that the natural course of moderate to severe mitral regurgitation in asymptomatic patients is not entirely benign. The purpose of this study was to investigate whether an operation at an early stage before worsening of functional class and left ventricular function or atrial fibrillation occur might improve long term prognosis.From 1987 to 2006 a consecutive series of 688 patients underwent surgery for degenerative mitral regurgitation and was followed retrospectively for risk factors like age, type of operation (reconstruction vs replacement), thrombo-embolism and bleeding episodes, reoperation for residual or recurrent regurgitation, NYHA class, left ventricular function and cardiac rhythm.Long-term survival was better and complications were fewer if the valve could be repaired rather than replaced. A preoperative lower functional class, better left ventricular function and sinus rhythm were significantly associated with improved survival and lower rates of atrial fibrillation late postoperatively. The analysis, however, is complicated by a slightly older age of patients with these risk factors. Conclusion: Surgery for degenerative, moderate to severe mitral regurgitation should be recommended before symptoms arise, cardiac function deteriorates or atrial fibrillation occurs, particularly if the valve can be repaired.

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The impact of mitral valve surgery combined with maze procedure☆

Cited by 61 publications

References 27 publications

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Chirurgie der degenerativen Mitralinsuffizienz auch beim asymptomatischen Patienten?

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