Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 140; no. 6; pp. 1332 - 1337
• Main Authors: Fujita, Tomoyuki, MD, Kobayashi, Junjiro, MD, Toda, Koichi, MD, Nakajima, Hiroyuki, MD, Iba, Yutaka, MD, Shimahara, Yusuke, MD, Yagihara, Toshikatu, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2010; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Fibrillation - complications; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Catheter Ablation - methods; Catheter Ablation - mortality; Chronic Disease; Echocardiography; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Pneumology; Proportional Hazards Models; Reconstructive Surgical Procedures - methods; Reconstructive Surgical Procedures - mortality; Reoperation; Survival Rate; Treatment Outcome; NYHA; New York Heart Association; 24; 35; atrial fibrillation; left ventricular (ventricle); left atrial (atrium); AF; LA; MR; mitral regurgitation; LV; Corrective surgery; Mitral valve; Prognosis; Cardiovascular disease; Long term; Treatment; Cardiac valvular disease; Maze procedure; Mitral regurgitation; Anesthesia; Valve; Circulatory system; Cardiology; Repair
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.01.030

Objective The long-term outcomes of combined mitral repair and maze procedure for patients with nonrheumatic mitral regurgitation and chronic atrial fibrillation were evaluated. Methods Between June 1992 and December 2008, 187 patients underwent a combined mitral repair and maze procedure. The mean follow-up period was 7.4 ± 4.3 years. Chordal reconstruction was performed in 69 patients, leaflet resection in 91, edge-to-edge leaflet suture in 30, and ring annuloplasty in 156. In addition, a cryo-maze procedure was applied in 110, and a Cox–Kosakai maze and radiofrequency maze were applied in the others. Results There were 2 operative deaths and the 15-year survival was 71%. The 15-year freedom from greater than grade 3 mitral regurgitation was 61%; rates of freedom from heart failure (New York Heart Association class ≥ III) and reoperations were 79% and 91%, respectively. Cardiac function was improved and left ventricular size was decreased significantly postoperatively. Multivariate analysis showed that a large left ventricular diastolic diameter (≥65 mm) was an independent risk factor for recurrent mitral regurgitation. Eleven thromboembolic episodes (0.79%/patient-year) were detected during follow-up examinations, of which 7 occurred in patients with recurrent atrial fibrillation. Sinus rhythm was regained in 86% after 6 months and in 63% after 15 years. Multivariate analysis showed that a small-voltage f wave was an independent risk factor for AF recurrence. Conclusions A combined mitral valve repair and maze procedure provided low rates of morbidity and mortality and led to well-preserved cardiac function. Left ventricular diastolic diameter and f-wave voltage can be accurate predictors of good long-term outcome.