RSS-Feed abonnieren
DOI: 10.1055/s-0034-1383719
Long-Term Outcomes after Mitral Valve Repair for Degenerative Mitral Regurgitation with Persistent Atrial Fibrillation
Publikationsverlauf
06. Februar 2014
15. Mai 2014
Publikationsdatum:
15. Juli 2014 (online)
![](https://www.thieme-connect.de/media/thoracic/201503/lookinside/thumbnails/10.1055-s-0034-1383719-1.jpg)
Abstract
Background Atrial fibrillation (AF) adversely affects surgical outcomes of mitral valve surgery. However, the long-term impact of Maze procedure has not been clear yet.
Patients and Methods We retrospectively investigated 159 patients who underwent mitral valve repair for degenerative mitral regurgitation with persistent AF between 1991 and 2010. The mean age of patients was 63.1 ± 10.5 years. After we started performing Maze procedure in 2002, 65 patients underwent concomitant Maze procedure. The median follow-up time was 7.5 years.
Results There was one operative death (0.63%). The overall survival rate was 91.0 ± 2.6% at 5 years and 79.1 ± 4.7% at 10 years. Survival was significantly better in patients who underwent Maze procedure than those who did not. The rate of freedom from AF in patients who underwent Maze procedure was 86.4 ± 4.5% at 1 year and 81.1 ± 5.6% at 5 years. The freedom rate from stroke was higher in patients who underwent Maze procedure than those who did not. Patients with postoperative AF had larger left ventricular systolic and diastolic diameters at follow-up and higher New York Heart Association functional class than patients without postoperative AF (1.4 ± 0.5 vs. 1.1 ± 0.3, p < 0.001).
Conclusion Maze procedure can have a positive effect on long-term survival, freedom from stroke, and cardiac function.
-
References
- 1 Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik JA, Enriquez-Sarano M. Very long-term survival and durability of mitral valve repair for mitral valve prolapse. Circulation 2001; 104 (12) (Suppl. 01) I1-I7
- 2 Braunberger E, Deloche A, Berrebi A , et al. Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation 2001; 104 (12) (Suppl. 01) I8-I11
- 3 Ngaage DL, Schaff HV, Mullany CJ , et al. Influence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified?. Ann Thorac Surg 2007; 84 (2) 434-442 , discussion 442–443
- 4 Bando K, Kasegawa H, Okada Y , et al. Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation. J Thorac Cardiovasc Surg 2005; 129 (5) 1032-1040
- 5 Fujita T, Kobayashi J, Toda K , et al. Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation. J Thorac Cardiovasc Surg 2010; 140 (6) 1332-1337
- 6 Carpentier A, Chauvaud S, Mihaileanu S, Classification of congenital malformations of the mitral valve and their surgical management. In: Crupi G, Parenzan L, Anderson RG. , eds. Perspectives in Pediatric Cardiology. Part 3: Pediatric Cardiac Surgery. Mt Kisco (NY): Futura Publishing Company; 1990: 97-102
- 7 Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg 1983; 86 (3) 323-337
- 8 David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 1991; 101 (3) 495-501
- 9 Ling LH, Enriquez-Sarano M, Seward JB , et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996; 335 (19) 1417-1423
- 10 Funatsu T, Kobayashi J, Nakajima H, Iba Y, Shimahara Y, Yagihara T. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg 2009; 36 (2) 267-271 , discussion 271
- 11 Nakajima H, Kobayashi J, Bando K , et al. The effect of cryo-maze procedure on early and intermediate term outcome in mitral valve disease: case matched study. Circulation 2002; 106 (12) (Suppl. 01) I46-I50
- 12 Lim E, Barlow CW, Hosseinpour AR , et al. Influence of atrial fibrillation on outcome following mitral valve repair. Circulation 2001; 104 (12) (Suppl. 01) I59-I63
- 13 Wi J, Choi JY, Shim JM , et al. Fate of preoperative atrial fibrillation after correction of atrial septal defect. Circ J 2013; 77 (1) 109-115
- 14 Khargi K, Hutten BA, Lemke B, Deneke T. Surgical treatment of atrial fibrillation; a systematic review. Eur J Cardiothorac Surg 2005; 27 (2) 258-265
- 15 Itoh A, Kobayashi J, Bando K , et al. The impact of mitral valve surgery combined with maze procedure. Eur J Cardiothorac Surg 2006; 29 (6) 1030-1035
- 16 Worku B, Pak SW, Cheema F , et al. Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation. Ann Thorac Surg 2011; 92 (6) 2085-2089
- 17 Lee CH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Left atrial appendage resection versus preservation during the surgical ablation of atrial fibrillation. Ann Thorac Surg 2014; 97 (1) 124-132