Combined radiofrequency modified maze and mitral valve procedure through a port access approach: early and mid-term results.
OBJECTIVE
The aim of this study was to assess the feasibility and effectiveness of irrigated radiofrequency (RF) modified Maze procedure through a port access approach during mitral valve surgery and evaluate early and mid-term results.


METHODS
During a 16 months time period, 67 patients with chronic atrial fibrillation (AF) eligible for port access mitral valve surgery were randomly assigned to either Group A, in which they underwent a combined procedure (N = 33) or Group B, in which a valve procedure alone was performed (N = 34). Both groups were similar in terms of age, sex, valve pathology, duration of AF left atrial diameter and left ventricle function (P > 0.05). Four had undergone previous operations.


RESULTS
Median follow-up was 10 months for both groups, 95% CI (9.18-10.8). One patient in each group died early postoperatively (3 and 2.9%). Two patients required reoperation for bleeding, one in each group (3 and 2.9%). There were two conversions to right thoracotomy. In Group A, freedom from AF was 100% at the end of the operation (76% sinus, 24% pacemaker) Six and twelve months freedom from AF was 87.2 and 93.6%, respectively. In Group B, freedom from AF at the end of operation was 41%. At the end of 6 and 12 months, freedom from AF was 9.4% (P = 0.0001). One patient in Group A required a permanent pacemaker (3%). During follow-up, one patient in Group A died of non-cardiac causes (3%). In Group B, there were two late deaths: one cardiac (2.9%) and one neurologic (2.9%). There were no thromboembolic events detected in Group A during follow-up, whereas two patients in Group B suffered this complication (6%, P = 0.081). At 12 months, functional capacity had improved for patients in both groups (P < 0.0001).


CONCLUSIONS
The combination of mitral valve surgery and irrigated RF Maze procedure was safe and efficient through a port access approach. There were no procedure related complications like esophageal or coronary artery injury. Early and mid-term results were favourable with 93.6% of patients free of AF at 1 year in comparison to the 9.4% of the control group. The data is not sufficient to reach any conclusions in terms of thromboembolic rates, despite favourable results for the RF Maze group. Nevertheless, in terms of feasibilty, sinus rhythm restoration and overall outcome, early results are encouraging and we advocate the use of the combined procedure through a port access approach.
Akpinar
Belhhan
B
Department of Cardiovascular Surgery, Florence Nightingale Hospital, Kadir Has University Medical Faculty, Istanbul, Turkey. belh@turk.net
Guden
Mustafa
M
Sagbas
Ertan
E
Sanisoglu
Ilhan
I
Ozbek
Ugur
U
Caynak
Baris
B
Bayindir
Osman
O
D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011292:Premedication; D011446:Prospective Studies
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone