Eight-year experience of combined valve repair for mitral regurgitation and maze procedure.
OBJECTIVE
Although atrial fibrillation (AF) is often associated with severe mitral regurgitation (MR), a simultaneous maze procedure for AF associated with repair of MR remains controversial. In this study, mid-term results of combined mitral valve repair and the maze procedure were examined.


METHODS
Between May 1992 and April 2001, 85 patients (61 males, 24 females) underwent valve repair for MR and the maze procedure. Mean age at surgery was 61.8+/-9.1 years; mean follow up was 4.7+/-2.3 years. Valve lesions were anterior in 26 patients (31%), posterior in 31 (36%), anterior + posterior in 23 (27%), and simple dilated annulus in five (6%). Chordal replacement with expanded PTFE sutures was performed in 40 patients (47%), and leaflet resection in 41 (48%). Ring annuloplasty was also applied in 61 patients (72%). Associated procedures were tricuspid valve annuloplasty in 33 (36%), coronary artery bypass grafting in four, atrial septal defect closure in two, aortic valve repair in one, and resection of abnormal septum in the left atrium in one.


RESULTS
There was one hospital death (1%), and one late death (1%). Reopening the chest for bleeding was necessary in six cases (7%). One thromboembolic episode was detected during follow up (0.25%/patient-year). Reoperation for MR was performed in three patients (4%). Actuarial event-free survival rate was 90.0+/-6.4% at eight years. Sinus rhythm was regained in 68 patients (81%), and atrial A-wave was detected in 57 (68%) by pulsed Doppler study. Postoperative left ventricular diastolic and systolic dimensions were significantly (p = 0.001 and p = 0.017) smaller in patients who restored sinus rhythm than in those who did not (48.6+/-4.6 versus 54.6+/-4.7 mm, and 33.0+/-6.0 versus 38.1+/-6.9 mm).


CONCLUSIONS
Combined mitral valve repair for MR and the maze procedure showed satisfactory midterm results. Postoperative sinus rhythm conversion by the maze procedure may reduce left ventricular size, and the incidence of thromboembolic episodes in mitral valve repair.
Kobayashi
Junjiro
J
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Sasako
Yoshikado
Y
Bando
Ko
K
Niwaya
Kazuo
K
Tagusari
Osamu
O
Nakajima
Hiroyuki
H
Ishida
Michiko
M
Kitamura
Soichiro
S
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D006348:Cardiac Surgical Procedures; D003131:Combined Modality Therapy; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome