Impact of maze procedure in patients with severe tricuspid regurgitation and persistent atrial fibrillation

Abstract Objective To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation. Methods All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model. Results We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127–1.874), area under ROC curve was 0.81, the Jordan index was 0.665. Conclusion The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.

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Intraoperative Modified Cox Mini-Maze Procedure for Long-Standing Persistent Atrial Fibrillation

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2007.12.037 ◽

2008 ◽

Vol 85 (4) ◽

pp. 1283-1289 ◽

Cited By ~ 11

Author(s):

Yong Qiang Cui ◽

Ling Bo Sun ◽

Yan Li ◽

Chun Lei Xu ◽

Jie Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Maze Procedure

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Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01336-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jiangang Wang ◽

Songnan Li ◽

Qing Ye ◽

Xiaolong Ma ◽

Yichen Zhao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Tricuspid Regurgitation ◽

Propensity Score Analysis ◽

Survival Rates ◽

Group Analysis ◽

Tricuspid Valve Repair ◽

Surgical Ablation ◽

Severe Tricuspid Regurgitation ◽

Recurrent Atrial Fibrillation

Abstract Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95–97.78) and 92.0% (95% CI: 85.26–95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan–Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

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Long-term results of the maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease

Heart and Vessels ◽

10.1007/s00380-011-0117-5 ◽

2011 ◽

Vol 27 (1) ◽

pp. 53-57 ◽

Cited By ~ 4

Author(s):

Yujiro Fukuda ◽

Teruhisa Yoshida ◽

Tomohito Inage ◽

Tomohiro Takeuchi ◽

Takeki Gondo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Left Ventricular Function ◽

Ventricular Function ◽

Mitral Valve Disease ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Maze Procedure ◽

Long Term Results

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Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis

10.21203/rs.3.rs-20938/v1 ◽

2020 ◽

Author(s):

Jiangang Wang ◽

Songnan Li ◽

Qing Ye ◽

Xiaolong Ma ◽

Yichen Zhao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Tricuspid Regurgitation ◽

Propensity Score Analysis ◽

Survival Rates ◽

Group Analysis ◽

Tricuspid Valve Repair ◽

Surgical Ablation ◽

Severe Tricuspid Regurgitation ◽

Recurrent Atrial Fibrillation

Abstract Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6mm and >= 6mm. Kaplan–Meier analysis showed in patients with tethering height < 6mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height >= 6mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

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An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0540 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Yan ◽

S.J Zhu ◽

M Zhu ◽

C.F Guo

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Vena Cava ◽

Persistent Atrial Fibrillation ◽

Maze Procedure ◽

Purse String ◽

Off Pump ◽

Bipolar Radiofrequency ◽

The Right

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

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