Outcomes and predictors of success of a radiofrequency- or cryothermy-simplified left-sided maze procedure in patients undergoing mitral valve surgery.
OBJECTIVE
Restoration of sinus rhythm with a maze procedure after concomitant mitral valve (MV) surgery has been shown to reduce the rate of stroke and improve cardiac function and quality of life compared to MV surgery alone. Unlike the classical Cox-Maze III operation, a simplified left-sided maze procedure can be performed without any significant increase in operative complexity.


METHODS
Outcomes were compared retrospectively between radiofrequency (RF) and cryothermy as an energy source and analyzed predictors of outcome in 73 consecutive patients undergoing MV surgery with a concomitant simplified left-sided maze procedure. Clinical characteristics as well as rhythm and complication rate at follow up were assessed by review of medical records and patient and physician interview.


RESULTS
There were no complications associated directly with the maze procedure. At an average follow up of 342 days, 69% of patients were in normal sinus rhythm. Of the remainder, 30% had recurrent atrial fibrillation (AF) and 1% atrial flutter. In addition, 7% of patients required cardioversion and 14% required anti-arrhythmic therapy to maintain sinus rhythm. Patients with recurrent AF were more likely to have an enlarged right atrium or Carpentier Type IIIa mitral regurgitation on preoperative echocardiography, and more likely to have undergone concomitant aortic or tricuspid valve surgery. There was no difference in outcome between RF and cryothermy as an energy source in unadjusted or adjusted analyses.


CONCLUSIONS
The results of the study helped to establish RF- or cryothermy-simplified left-sided maze procedure as being efficacious and without associated complications in patients having MV surgery and a history of AF. Further investigations are warranted to better define the clinical predictors of recurrent AF to improve patient selection and potentially to modify current maze techniques.
Gehi
Anil K
AK
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029-6574, USA.
Adams
David H
DH
Salzberg
Sacha P
SP
Filsoufi
Farzan
F
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D017679:Cryotherapy; D005260:Female; D007839:Functional Laterality; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery; D011846:Radio Waves; D012042:Registries; D012189:Retrospective Studies; D016277:Ventricular Function, Left