Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease: effects of the cryo-maze procedure and predictors for late recurrence

Man Jong Baek, Chan Young Na, Sam Se Oh, Chang Ha Lee, Jae Hyun Kim, Hong Joo Seo, Sang Won Park, Wook Sung Kim

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: The aim of this study was to evaluate the effects of the modified maze procedure using cryoablation for treating chronic atrial fibrillation (AF) associated with rheumatic mitral valve disease and to assess the risk factors for late failure of sinus rhythm restoration. Methods: Between March 2000 and June 2004, 170 consecutive patients, who underwent the modified maze procedure using cryoablation concomitant with mitral valve surgery for atrial fibrillation associated with rheumatic mitral valve disease, were divided into two groups based on the type of right-sided maze: the modified Cox-maze III (CM group, n = 93) and modified Kosakai-maze (KM group, n = 77) procedures. The postoperative and mid-term follow-up results were analyzed and compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of atrial fibrillation. Results: There were three in-hospital deaths, including two in the CM group (2.2%) and one in the KM group (1.3%), and there were no significant differences in the incidence of postoperative complications between the two groups. The cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the KM group than the CM group. At discharge, the sinus rhythm rate was 70% in the CM group and 74% in the KM group (p = 0.55). Follow-up was completed in 97% of the patients, with a mean time of 26.6 ± 15.2 months. At the latest follow-up, one death occurred in the CM group (0.6%). Sinus rhythm was documented in 141 (84%) out of all the patients, including 76 (84%) in the CM group and 65 (86%) in the KM group (p = 0.72). The 4-year actuarial survival free from stroke was 90.3 ± 5.9% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.68), and 4-year event-free survival was 81.2 ± 7.4% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.078). Using a multivariate analysis, a left atrial dimension >65 mm (p = 0.011) and repair for rheumatic mitral valve disease (p = 0.038) were independent risk factors for a late recurrence of AF. Conclusions: The modified maze procedures using cryoablation are safe and effective in treating chronic atrial fibrillation associated with rheumatic mitral valve disease.

Original languageEnglish
Pages (from-to)728-736
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume30
Issue number5
DOIs
Publication statusPublished - 2006 Nov 1

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Mitral Valve
Atrial Fibrillation
Cryosurgery
Recurrence
Multivariate Analysis
Therapeutics
Cardiopulmonary Bypass
Disease-Free Survival
Stroke
Survival
Incidence

Keywords

  • Arrhythmia surgery
  • Atrial fibrillation
  • Cryoablation
  • Mitral valve
  • Rheumatic

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease : effects of the cryo-maze procedure and predictors for late recurrence. / Baek, Man Jong; Na, Chan Young; Oh, Sam Se; Lee, Chang Ha; Kim, Jae Hyun; Seo, Hong Joo; Park, Sang Won; Kim, Wook Sung.

In: European Journal of Cardio-thoracic Surgery, Vol. 30, No. 5, 01.11.2006, p. 728-736.

Research output: Contribution to journalArticle

Baek, Man Jong ; Na, Chan Young ; Oh, Sam Se ; Lee, Chang Ha ; Kim, Jae Hyun ; Seo, Hong Joo ; Park, Sang Won ; Kim, Wook Sung. / Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease : effects of the cryo-maze procedure and predictors for late recurrence. In: European Journal of Cardio-thoracic Surgery. 2006 ; Vol. 30, No. 5. pp. 728-736.
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abstract = "Objective: The aim of this study was to evaluate the effects of the modified maze procedure using cryoablation for treating chronic atrial fibrillation (AF) associated with rheumatic mitral valve disease and to assess the risk factors for late failure of sinus rhythm restoration. Methods: Between March 2000 and June 2004, 170 consecutive patients, who underwent the modified maze procedure using cryoablation concomitant with mitral valve surgery for atrial fibrillation associated with rheumatic mitral valve disease, were divided into two groups based on the type of right-sided maze: the modified Cox-maze III (CM group, n = 93) and modified Kosakai-maze (KM group, n = 77) procedures. The postoperative and mid-term follow-up results were analyzed and compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of atrial fibrillation. Results: There were three in-hospital deaths, including two in the CM group (2.2{\%}) and one in the KM group (1.3{\%}), and there were no significant differences in the incidence of postoperative complications between the two groups. The cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the KM group than the CM group. At discharge, the sinus rhythm rate was 70{\%} in the CM group and 74{\%} in the KM group (p = 0.55). Follow-up was completed in 97{\%} of the patients, with a mean time of 26.6 ± 15.2 months. At the latest follow-up, one death occurred in the CM group (0.6{\%}). Sinus rhythm was documented in 141 (84{\%}) out of all the patients, including 76 (84{\%}) in the CM group and 65 (86{\%}) in the KM group (p = 0.72). The 4-year actuarial survival free from stroke was 90.3 ± 5.9{\%} for the CM group and 96.4 ± 3.5{\%} for the KM group (p = 0.68), and 4-year event-free survival was 81.2 ± 7.4{\%} for the CM group and 96.4 ± 3.5{\%} for the KM group (p = 0.078). Using a multivariate analysis, a left atrial dimension >65 mm (p = 0.011) and repair for rheumatic mitral valve disease (p = 0.038) were independent risk factors for a late recurrence of AF. Conclusions: The modified maze procedures using cryoablation are safe and effective in treating chronic atrial fibrillation associated with rheumatic mitral valve disease.",
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author = "Baek, {Man Jong} and Na, {Chan Young} and Oh, {Sam Se} and Lee, {Chang Ha} and Kim, {Jae Hyun} and Seo, {Hong Joo} and Park, {Sang Won} and Kim, {Wook Sung}",
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T1 - Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease

T2 - effects of the cryo-maze procedure and predictors for late recurrence

AU - Baek, Man Jong

AU - Na, Chan Young

AU - Oh, Sam Se

AU - Lee, Chang Ha

AU - Kim, Jae Hyun

AU - Seo, Hong Joo

AU - Park, Sang Won

AU - Kim, Wook Sung

PY - 2006/11/1

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N2 - Objective: The aim of this study was to evaluate the effects of the modified maze procedure using cryoablation for treating chronic atrial fibrillation (AF) associated with rheumatic mitral valve disease and to assess the risk factors for late failure of sinus rhythm restoration. Methods: Between March 2000 and June 2004, 170 consecutive patients, who underwent the modified maze procedure using cryoablation concomitant with mitral valve surgery for atrial fibrillation associated with rheumatic mitral valve disease, were divided into two groups based on the type of right-sided maze: the modified Cox-maze III (CM group, n = 93) and modified Kosakai-maze (KM group, n = 77) procedures. The postoperative and mid-term follow-up results were analyzed and compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of atrial fibrillation. Results: There were three in-hospital deaths, including two in the CM group (2.2%) and one in the KM group (1.3%), and there were no significant differences in the incidence of postoperative complications between the two groups. The cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the KM group than the CM group. At discharge, the sinus rhythm rate was 70% in the CM group and 74% in the KM group (p = 0.55). Follow-up was completed in 97% of the patients, with a mean time of 26.6 ± 15.2 months. At the latest follow-up, one death occurred in the CM group (0.6%). Sinus rhythm was documented in 141 (84%) out of all the patients, including 76 (84%) in the CM group and 65 (86%) in the KM group (p = 0.72). The 4-year actuarial survival free from stroke was 90.3 ± 5.9% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.68), and 4-year event-free survival was 81.2 ± 7.4% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.078). Using a multivariate analysis, a left atrial dimension >65 mm (p = 0.011) and repair for rheumatic mitral valve disease (p = 0.038) were independent risk factors for a late recurrence of AF. Conclusions: The modified maze procedures using cryoablation are safe and effective in treating chronic atrial fibrillation associated with rheumatic mitral valve disease.

AB - Objective: The aim of this study was to evaluate the effects of the modified maze procedure using cryoablation for treating chronic atrial fibrillation (AF) associated with rheumatic mitral valve disease and to assess the risk factors for late failure of sinus rhythm restoration. Methods: Between March 2000 and June 2004, 170 consecutive patients, who underwent the modified maze procedure using cryoablation concomitant with mitral valve surgery for atrial fibrillation associated with rheumatic mitral valve disease, were divided into two groups based on the type of right-sided maze: the modified Cox-maze III (CM group, n = 93) and modified Kosakai-maze (KM group, n = 77) procedures. The postoperative and mid-term follow-up results were analyzed and compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of atrial fibrillation. Results: There were three in-hospital deaths, including two in the CM group (2.2%) and one in the KM group (1.3%), and there were no significant differences in the incidence of postoperative complications between the two groups. The cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the KM group than the CM group. At discharge, the sinus rhythm rate was 70% in the CM group and 74% in the KM group (p = 0.55). Follow-up was completed in 97% of the patients, with a mean time of 26.6 ± 15.2 months. At the latest follow-up, one death occurred in the CM group (0.6%). Sinus rhythm was documented in 141 (84%) out of all the patients, including 76 (84%) in the CM group and 65 (86%) in the KM group (p = 0.72). The 4-year actuarial survival free from stroke was 90.3 ± 5.9% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.68), and 4-year event-free survival was 81.2 ± 7.4% for the CM group and 96.4 ± 3.5% for the KM group (p = 0.078). Using a multivariate analysis, a left atrial dimension >65 mm (p = 0.011) and repair for rheumatic mitral valve disease (p = 0.038) were independent risk factors for a late recurrence of AF. Conclusions: The modified maze procedures using cryoablation are safe and effective in treating chronic atrial fibrillation associated with rheumatic mitral valve disease.

KW - Arrhythmia surgery

KW - Atrial fibrillation

KW - Cryoablation

KW - Mitral valve

KW - Rheumatic

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