Effect of maze procedure in patients with atrial fibrillation undergoing valve replacement

Abstract

Background and aims of the study: The study aim was to elucidate the impact of the maze procedure on late outcome after valve replacement.

Methods: Between 1992 and 2000, 241 patients underwent the maze procedure combined with valve replacement. Patients were allocated to three groups: aortic valve replacement (AVR/maze, n = 16); mitral valve replacement (MVR/maze, n = 148); and combined aortic and mitral valve replacement (DVR/maze, n = 77).

Results: Mean follow up was 3.9 +/- 2.3 years. Hospital mortality was 0% in the AVR/maze group, 2.0% (n = 3) in the MVR/maze group, and 3.9% (n = 3) in the DVR/maze group. Elimination of atrial fibrillation (AF) at discharge was achieved in 74.3-75.9% of cases. Freedom from recurrence of AF/atrial flutter was 71.2% in the AVR/maze group, 68.2% in the MVR/maze group, and 64.0% in the DVR/maze group at five-year follow up. By multivariate analysis, risk factors for recurrence of AF/atrial flutter included preoperative enlarged left atrial dimension >70 mm, decreased postoperative fractional shortening <30%, and absence of postoperative left atrial contraction. Freedom from stroke was 93.6% in patients who achieved regular rhythm (normal sinus rhythm or junctional rhythm), and 80.9% in those with recurrence of AF at five years after surgery (p = 0.03).

Conclusion: The combined maze procedure and valve replacement is safe and effective in selected patients. Restoration of regular rhythm significantly reduced the incidence of late stroke.