Abstract 9658: Concomitant Maze Procedure Reduces Adverse Clinical Events in Patients with Left Ventricular Dysfunction Undergoing Open Cardiac Surgery

Abstract

Background: Clinical benefits of concomitant maze procedure can be offset by surgical risks added by the procedure especially in patients with left ventricular (LV) dysfunction undergoing open heart surgery. Methods: Between January 1999 and March 2011, a total of 139 patients (mean age 52.7±12.3 years, 54 females) with valvular atrial fibrillation (AF) and a LV ejection fraction (EF) of 40% or less underwent open heart surgery with (n=77) or without (n=62) the concomitant maze procedure. We compared primary adverse outcomes (death; composite of death, thromboembolic events, or congestive heart failure [CHF]) during a median follow-up period of 66.9 months (inter-quartile range, 27.8-105.5 months). Results: Primary outcomes occurred in 41 patients including 36 deaths, 7 thromboembolic events and 8 hospitalizations due to CHF. After adjustment for baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 0.48; 95% confidence interval, 0.17-1.35; P =0.17) but a significantly lower risk of the composite adverse outcomes (hazard ratio, 0.34; 95% confidence interval, 0.14-0.83; P =0.017) compared with those who did not undergo the maze procedure (Figure). For 23 propensity-score matched pairs, the combination of the maze procedure resulted in decreased LV systolic ( P =0.013) and diastolic ( P =0.041) dimensions, and increased LV EF (56.2±7.9% vs. 49.9±11.9%, P =0.010) compared with cardiac surgery alone on echocardiographic assessments performed at a median of 62.8 months (inter-quartile range, 26.5-119.0 months) after surgery. At the end of follow-up, patients who had undergone the maze procedure had superior New York Heart Association functional status than those who did not ( P =0.008). Conclusion: Adding the maze procedure in patients with valvular AF and LV dysfunction reduced adverse outcomes, and improved LV systolic function and functional status as compared with cardiac surgery alone.