Restoration of Sinus Rhythm by the Maze Procedure Halts Progression of Tricuspid Regurgitation After Mitral Surgery

Abstract

Tricuspid regurgitation (TR) is common in patients undergoing mitral valve surgery, and atrial fibrillation (AF) can cause progression of TR. This study examined the hypothesis that correction of AF with the Maze procedure can prevent the late progression of TR after mitral valve surgery. We compared severity of TR in 33 patients (January 1, 1993, to January 1, 2003) who underwent concomitant Maze procedure plus mitral valve surgery and converted to normal sinus rhythm postoperatively with case-matched control patients who underwent mitral valve surgery alone and remained in AF postoperative. Matched variables were age, sex, diabetes mellitus, left ventricular ejection fraction, and hypertension. Preoperative TR grade was similar between groups (Maze 2.2 +/- 0.8 versus no-Maze 2.3 +/- 0.8, p = 0.67). Patients with permanent transvenous pacemakers, organic tricuspid valve disease, and prior tricuspid valve surgery were excluded from this comparison. Before hospital dismissal, average TR grade improved to 1.9 +/- 0.9 in both groups; TR improved in 42% of patients in the Maze group and 36% of patients with preoperative AF and no Maze. At last follow-up, average TR grade remained stable at 1.9 +/- 0.9 in the Maze group (p = 0.078 versus preoperative) with TR progression in only 9% of patients (3 of 33). In contrast, TR grade worsened to 2.7 +/- 0.9 in the no-Maze group (p = 0.04 versus preoperative, p < 0.001 versus postoperative, p < 0.001 versus groups), and TR worsened in 45% of patients (15 of 33). In a multivariable model, performance of a Maze procedure was protective against the progression of TR. Continued AF after mitral valve surgery can predispose a patient to progression of TR, and this progression is prevented in patients having successful concomitant Maze procedure.