The influence of postoperative mitral valve function on the late recurrence of atrial fibrillation after the maze procedure combined with mitral valvuloplasty

Kim, Joon Bum; Lee, Seung Hyun; Jung, Sung Ho; Yun, Sung Cheol; Choo, Suk Jung; Chung, Cheol Hyun; Song, Hyun; Lee, Jae Won

doi:10.1016/j.jtcvs.2009.07.042

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 5 , Pages 1170-1176, May 2010

The influence of postoperative mitral valve function on the late recurrence of atrial fibrillation after the maze procedure combined with mitral valvuloplasty

Joon Bum Kim, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Seung Hyun Lee, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Sung Ho Jung, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Sung Cheol Yun, PhD
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Suk Jung Choo, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Cheol Hyun Chung, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Hyun Song, MD
- Department of Thoracic and Cardiovascular Surgery, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
Jae Won Lee, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Address for reprints: Jae Won Lee, MD, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong Songpa-gu, Seoul 138-736, South Korea.

Received 21 February 2009; received in revised form 9 June 2009; accepted 16 July 2009. published online 23 September 2009.

Objectives

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.

CTSNet classification: 24, 35

Abbreviations and Acronyms: AF, atrial fibrillation, CI, confidence interval, HR, hazard ratio, LA, left atrium, MR, mitral regurgitation, MV, mitral valve