The influence of postoperative mitral valve function on the late recurrence of atrial fibrillation after the maze procedure combined with mitral valvuloplasty.
OBJECTIVE
Although a number of reports have identified risk factors for postoperative recurrence of atrial fibrillation after the maze procedure, no studies have investigated the influence of postoperative mitral valve disease on atrial fibrillation recurrence after mitral valvuloplasty combined with the maze procedure.


METHODS
Between January 1999 and October 2006, 228 patients underwent the maze procedure and concomitant mitral valve repair. There were 4 early deaths. Of the early survivors, 206 patients with restored sinus rhythm were chosen for analysis. During a median follow-up of 50.8 months (range, 0.6-122.8 months), there were 35 patients who had mitral regurgitation (n = 26) or mitral stenosis (n = 9). Patients who had postoperative mitral valve disease (disease group, n = 35) were compared with those who did not (control group, n = 171) for late recurrence of atrial fibrillation.


RESULTS
Twenty-eight patients experienced late recurrence of atrial fibrillation. The disease group had a higher atrial fibrillation recurrence rate than the control group (5-year atrial fibrillation-free rates were 65.2% +/- 10.3% and 85.8% +/- 3.4%, respectively; P = .014). Univariate and multivariate analyses of a range of variables revealed that a larger preoperative left atrial size (hazard ratio, 2.61; P = .041), the use of microwave ablation rather than cryoablation (hazard ratio, 2.33; P = .041), the presence of early (<3 months) postoperative atrial fibrillation events (hazard ratio, 3.75; P = .001), and the presence of postoperative mitral valve disease (hazard ratio, 3.67; P = .005) were independent predictors for late atrial fibrillation recurrence.


CONCLUSIONS
Maze procedure outcomes were negatively affected by postoperative mitral valve disease after mitral valvuloplasty, as evidenced by greater atrial fibrillation recurrence.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Joon Bum
JB
Kim
Seung Hyun
SH
Lee
Sung Ho
SH
Jung
Sung Cheol
SC
Yun
Suk Jung
SJ
Choo
Cheol Hyun
CH
Chung
Hyun
H
Song
Jae Won
JW
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult