Comparative efficacy of the maze procedure for postoperative sinus rhythm restoration with and without concomitant tricuspid annuloplasty during mitral valve surgery.

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-07-01 Epub Date: 2025-02-21 DOI:10.1007/s12055-025-01894-y

Fumio Yamana, Keitaro Domae, Masatoshi Hata, Yukitoshi Shirakawa, Takafumi Masai, Yoshiki Sawa

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引用次数: 0

Abstract

Introduction: There are limited studies evaluating the impact of concomitant tricuspid annuloplasty (TAP) on maze surgery outcomes in atrial fibrillation (AF) patients undergoing mitral valve (MV) surgery. This study aimed to assess the efficacy of the maze procedure in restoring sinus rhythm (SR) post-MV surgery, with and without concomitant TAP.

Methods: We reviewed 88 patients who underwent MV surgery with the maze procedure from January 2010 to December 2020. The primary endpoints included the 5-year postoperative SR restoration rate in patients undergoing bi-atrial maze (BM) versus left atrial maze (LM) procedures, with and without concomitant TAP, and the identification of risk factors for postoperative arrhythmia in the total cohort. Secondary outcomes included hospital mortality, postoperative heart failure, stroke, and pacemaker implantation.

Results: The 30-day mortality rate in the study population was 2.3%. There was no significant difference in SR restoration at hospital discharge between the BM and LM groups (BM, 76.2%; LM, 73.9%; p=0.80). In patients who did not undergo TAP, the 5-year SR restoration rates between the BM and LM groups were not significantly different (log-rank test: p=0.65). However, in those undergoing TAP, the BM group demonstrated a significantly higher 5-year SR restoration rate compared to the LM group (BM+TAP, 74.2% vs LM+TAP, 42.1%; log-rank test: p=0.044). Multivariate analysis identified TAP with the LM procedure (hazard ratio (HR), 2.94; 95% confidence interval (CI), 1.25-6.92; p=0.014) and long-standing persistent atrial fibrillation (AF) (HR, 3.35; 95% CI, 1.46-7.68; p=0.0044) as significant predictors of postoperative arrhythmia.

Conclusion: The BM procedure may be crucial in restoring postoperative SR, particularly in patients undergoing concomitant TAP during MV surgery.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01894-y.

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迷宫法在二尖瓣手术中合并和不合并三尖瓣环成形术后恢复窦性心律的疗效比较。

导语：目前评估合并三尖瓣环成形术（TAP）对房颤（AF）患者二尖瓣（MV）手术迷宫手术结果的影响的研究有限。本研究的目的是评估迷宫程序在恢复窦性心律（SR）后的mv手术，有和没有合并TAP的有效性。方法：我们回顾了2010年1月至2020年12月期间88例采用迷宫手术的MV手术患者。主要终点包括双心房迷宫（BM）和左心房迷宫（LM）手术患者的5年术后SR恢复率，合并和不合并TAP，以及确定整个队列中术后心律失常的危险因素。次要结局包括住院死亡率、术后心力衰竭、中风和起搏器植入。结果：研究人群的30天死亡率为2.3%。BM组和LM组出院时SR恢复无显著差异(BM, 76.2%；LM, 73.9%;p = 0.80)。在未接受TAP治疗的患者中，BM组和LM组的5年SR恢复率无显著差异（log-rank检验：p=0.65）。然而，在接受TAP的患者中，BM组的5年SR恢复率明显高于LM组(BM+TAP, 74.2% vs LM+TAP, 42.1%；Log-rank检验：p=0.044)。多因素分析发现TAP与LM程序(风险比（HR）， 2.94；95%置信区间（CI） 1.25-6.92；p=0.014)和长期持续性心房颤动（AF） (HR, 3.35；95% ci, 1.46-7.68；P =0.0044)作为术后心律失常的重要预测因素。结论：颅脑手术可能是恢复术后SR的关键，特别是在MV手术中同时进行TAP的患者。图片摘要：补充信息：在线版本包含补充资料，可在10.1007/s12055-025-01894-y获得。

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来源期刊

Indian Journal of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

1.20

自引率

14.30%

发文量

141

期刊介绍： The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.