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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 February;44(1):9-18

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

Jessurun E. R., Van Hemel N. M., Defauw J. J., Brutel De La Rivière A., Stofmeel M. A. M., Kelder J. C., Kingma J. H., Ernst J. M. P. G.

Departments of Cardiology and Cardio-Thoracic Surgery St. Antonius Hospital, Nieuwegein, The Netherlands


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Aim. Mitral ­valve sur­gery sel­dom sup­press­es atri­al fib­ril­la­tion (AF), ­present ­prior to sur­gery. Maze ­III sur­gery elim­i­nates AF in >80% of cas­es, ­the rea­son ­why com­bin­ing ­this pro­ce­dure ­with ­mitral ­valve sur­gery in ­patients ­with AF ­seems worth­while. We pros­pec­tive­ly stud­ied ­the out­come of com­bin­ing ­the Maze ­III pro­ce­dure ­with ­mitral ­valve sur­gery.
Methods. Thirty-five ­patients ­with AF ­and a ­mean ­age of 64 ­years under­go­ing ­mitral ­valve sur­gery ­were pros­pec­tive­ly ran­dom­ized accord­ing to a 2.5:1 ­ratio to sur­gery ­with (n=25), or with­out (n=10) ­maze ­III ­and fol­lowed ­for at ­least 1 ­year.
Results. At dis­charge ­and ­after 12 ­months free­dom ­from AF ­was 56% ­and 92%, respec­tive­ly, in ­the ­maze ­group, ­and 0% ­and 20%, respec­tive­ly, in ­patients with­out ­maze (­group dif­fer­enc­es at dis­charge p=0.002, ­after 12 ­months p=0.0007). Sinus ­node incom­pe­tence ­was ­seen in 1 of 25 ­maze ­patients requir­ing pac­ing. No in-hos­pi­tal or ­late ­death ­occurred; ­stroke ­was ­observed in 1 ­patient (with­out ­maze). Quality of ­life mark­ed­ly ­improved ­after sur­gery, ­but ­did ­not dif­fer ­between ­patients ­with or with­out ­maze sur­gery.
Conclusion. This ­first pros­pec­tive ran­dom­ized ­study ­shows ­that com­bin­ing ­maze ­III ­with ­mitral ­valve sur­gery result­ed in a sig­nif­i­cant­ly bet­ter elim­i­na­tion of pre­op­er­a­tive AF ­than ­mitral ­valve sur­gery ­alone. As ­the qual­ity of ­life ­did ­not dif­fer ­between ­patients ­with, or with­out ­maze sur­gery, addi­tion­al ­maze sur­gery is pri­mar­i­ly rec­om­mend­ed in ­patients in ­whom anti­co­ag­u­la­tion ther­a­py ­can be avoid­ed ­after sur­gery, spe­cif­i­cal­ly in ­patients ­with sched­uled ­mitral ­valve plas­ty.

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