{"title":"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。","authors":"Fumio Yamana, Keitaro Domae, Masatoshi Hata, Yukitoshi Shirakawa, Takafumi Masai, Yoshiki Sawa","doi":"10.1007/s12055-025-01894-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%; <i>p</i>=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: <i>p</i>=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: <i>p</i>=0.044). Multivariate analysis identified TAP with the LM procedure (hazard ratio (HR), 2.94; 95% confidence interval (CI), 1.25-6.92; <i>p</i>=0.014) and long-standing persistent atrial fibrillation (AF) (HR, 3.35; 95% CI, 1.46-7.68; <i>p</i>=0.0044) as significant predictors of postoperative arrhythmia.</p><p><strong>Conclusion: </strong>The BM procedure may be crucial in restoring postoperative SR, particularly in patients undergoing concomitant TAP during MV surgery.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01894-y.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"843-851"},"PeriodicalIF":0.7000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170483/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative efficacy of the maze procedure for postoperative sinus rhythm restoration with and without concomitant tricuspid annuloplasty during mitral valve surgery.\",\"authors\":\"Fumio Yamana, Keitaro Domae, Masatoshi Hata, Yukitoshi Shirakawa, Takafumi Masai, Yoshiki Sawa\",\"doi\":\"10.1007/s12055-025-01894-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%; <i>p</i>=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: <i>p</i>=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: <i>p</i>=0.044). Multivariate analysis identified TAP with the LM procedure (hazard ratio (HR), 2.94; 95% confidence interval (CI), 1.25-6.92; <i>p</i>=0.014) and long-standing persistent atrial fibrillation (AF) (HR, 3.35; 95% CI, 1.46-7.68; <i>p</i>=0.0044) as significant predictors of postoperative arrhythmia.</p><p><strong>Conclusion: </strong>The BM procedure may be crucial in restoring postoperative SR, particularly in patients undergoing concomitant TAP during MV surgery.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01894-y.</p>\",\"PeriodicalId\":13285,\"journal\":{\"name\":\"Indian Journal of Thoracic and Cardiovascular Surgery\",\"volume\":\"41 7\",\"pages\":\"843-851\"},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170483/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12055-025-01894-y\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-01894-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/21 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Comparative efficacy of the maze procedure for postoperative sinus rhythm restoration with and without concomitant tricuspid annuloplasty during mitral valve surgery.
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.
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.
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