A Decade Experience in Modified Maze Procedure in Atrial Fibrillation Associated With Mitral Valve Disease

Choosak Kasemsarn, Pramote Porapukkham, Piyawat Lerdsomboon, Jukkapant Jumpatade

Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–A

Abstract

Introduction: The association between mitral valve disease and atrial fibrillation (AF) is common. A simplified Maze with radiofrequency ablation is good result with low risk. Atrial reduction would improve better outcome.

Material and Method: From June 2004 to November 2017, a radiofrequency ablation concomitant with mitral valve operation was performed on 366 patients. All patients presented with permanent atrial fibrillation. The underlying diseases were rheumatic heart disease in 240 patients (65.6%), degenerative heart disease in 123 patients (33.6%), and congenital heart disease in 3 patients (0.8%). Left atrial reduction was done on 335 patients (91.5%).

Results: Valve replacement was performed in 174 patients (47.5%), mitral valve repair in 192 (52.5%). We had 6 operative deaths (1.9%). Eight patients (2.1%) need permanent pacemaker implantation. Atrial fibrillation disappeared in 92% immediate after operation, 73.7% on day seven, 88.7%, 82% , 81.6%, and 64.7% at 1,5,7, and 10 year. We found preoperative left atrial size larger than 60 mm. (p=0.018), postoperative left atrium bigger than 50 mm. (p<0.001), technique of reduction if left atrium >60 mm. (p=0.005), and AF on day 7 (p< 0.001) are factors influence success. Overall survival rate, mechanical valve replacement patients nonAF patients are better than AF one (p=0.031).

Conclusion: Radiofrequency ablation combined with mitral valve surgery is safe and beneficial to continuous AF concomitant with mitral valve disease patients.