title: Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure.
abstract: BACKGROUND
  The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear.
  
  
  RESULTS
  We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation-associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65-2.03; P=0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50-1.34; P=0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12-0.73; P=0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2-149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0-3) subgroup (P=0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup (P=0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular (P<0.001) and tricuspid valvular functions (P<0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0-146.8 months) after surgery.
  
  
  CONCLUSIONS
  Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
authors.forename: Joon
authors.initials: J
authors.lastname: Bum Kim
authors.forename: Joon
authors.initials: J
authors.lastname: Suk Moon
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Wan
authors.initials: W
authors.lastname: Kee Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Suk
authors.initials: S
authors.lastname: Jung Choo
authors.forename: Hyun
authors.initials: H
authors.lastname: Song
authors.forename: Cheol
authors.initials: C
authors.lastname: Hyun Chung
authors.forename: Jae
authors.initials: J
authors.lastname: Won Lee
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D003452:Cryosurgery; D004696:Endocarditis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D000925:Anticoagulants; D002317:Cardiovascular Agents