Abstract 18398: Long-term Surgical Outcome of Mitral Valve Repair for Degenerative Mitral Regurgitation with Chronic Atrial Fibrillation: The Impact of Maze Procedure on Long-term Survival and Cardiac Function

Abstract

Introduction: It is unclear whether maze procedure for atrial fibrillation (AF) would positively affect long-term survival, stroke and cardiac function. The aim of this study is to investigate the long-term surgical outcomes of mitral valve repair for degenerative mitral regurgitation with chronic AF and to determine the impact of concomitant maze procedures on long-term survival, cardiac events, stroke and cardiac function, comparing the outcomes of patients who underwent maze procedure and patients who did not undergo maze procedure. Methods: We retrospectively investigated 159 patients who underwent mitral valve repair for degenerative mitral regurgitation with chronic AF between 1991 and 2010. The mean age was 63.1±10.5 years old. We started Cox-maze IV procedure in 2002. As a result, 65 patients underwent concomitant maze procedure (maze(+) group) and 94 patients did not undergo maze procedure (maze(-) group). Follow-up was completed in 156 patients (98.1%). The median follow-up duration was 7.6 years (max 21 years). Results: There was one operative death (0.63%). The survival rate was significantly better in the maze(+) group than maze(-) group (5-year survival; 100% vs 85.2±4.0%, p<0.001). The actual freedom from atrial fibrillation in the maze(+) group was 86.4±4.5% at 1 year and 81.1±5.6% at 5 years. The actual freedom from cardiac events (cardiac death, cardiac-related re-admission and re-operation) was not different between the maze(+) group and maze(-) group (5-year freedom rate; 81.6±5.9% vs 88.9±3.5%, p=0.113). The rate of freedom from stroke was better in the maze(+) group than maze (-) group (5-year freedom rate; 92.1±3.9% vs 82.6±4.2%), though the difference of them was not statistically significant (Log-rank p=0.081). The latest NYHA functional class was worse in the patients who did not covert to sinus rhythm (AF group) than who did (SR group)(1.4±0.5 vs 1.1±0.3, p<0.001). The systolic and diastolic diameter of left ventricle gradually enlarged in AF group, which became significant difference during the long-term period. Conclusions: Maze procedure can improve long-term survival, rate of freedom from stroke and cardiac function in the patients with degenerative mitral regurgitation with chronic atrial fibrillation.