Cardiac valve prosthesis implantation and surgical maze ablation for the treatment of valvular disease with atrial fibrillation

doi:10.3969/j.issn.2095-4344.2317

Abstract

Abstract:

BACKGROUND: Patients with mitral valve disease have a higher incidence of atrial fibrillation after mitral valve replacement and mitral annuloplasty. Maze surgery is the gold standard for surgical treatment of atrial fibrillation. The effect of artificial valve and valve ring on maze surgery is not clear.

OBJECTIVE: To evaluate the changes of sinus rhythm-left atrial contractive function after surgical maze ablation of valvular atrial fibrillation and whether valve replacement or valve ring implantation affects the recovery of sinus rhythm-left atrial contractive function.

METHODS: From October 2013 to October 2017, 324 patients who underwent surgical maze ablation due to mitral valve lesions associated with persistent or long-term persistent atrial fibrillation in the General Hospital of Northern Theater Command were enrolled. All patients were treated with artificial valve replacement or artificial valve ring implantation after maze operation. The patients were followed up by electrocardiogram and echocardiography at discharge and 1, 3, 6, 12 and 24 months after procedure. A multivariate Cox analysis of predictive factors for left atrial contractive function recuperation was applied. This study was approved by the Medical Ethics Committee of General Hospital of Northern Theater Command (original General Hospital of Shenyang Military Region of Chinese PLA).

RESULTS AND CONCLUSION: (1) Two patients (0.6%) died during the perioperative period, and the remaining 322 patients were followed up for 2 years. There were no adverse events related to artificial materials during the follow-up. (2) The recovery rate of left atrial contractive function increased gradually after procedure. The coexistence consistency of left atrial contractive function and sinus rhythm was good until 1 year after surgery (Kappa coefficient ≥ 0.75, P < 0.05). Two years after maze procedure, the recovery rates of sinus rhythm and left atrial contractive function were 86.6% and 85.1%, respectively. (3) Cox multiple regression analysis showed that long duration of preoperative atrial fibrillation, large preoperative left atrial diameter, loss of left atrial contractive function 3 months after surgery, and cryoablation were the common predictors of sinus rhythm and left atrial contractive function recovery in the middle and late stages (> 3 months) after surgical maze ablation (all P values < 0.05). Long duration of preoperative atrial fibrillation, large preoperative left atrial diameter, incision and suture modes were the predictors of the recovery of left atrial systolic force (P < 0.05). Valvular replacement or valve ring implantation, material type and prosthesis pattern were not the factors that affect the recovery of atrial fibrillation and left atrial systolic force in the middle and late stages (P > 0.05). (4) ROC curve analysis showed that the optimal critical value of preoperative atrial fibrillation time and preoperative left atrial diameter for prediction of left arterial contractive function recovery was 36.5 months (sensitivity 90.5%, specificity 93.7%) and 60.5 mm (sensitivity 93.8%, specificity 85.0%) respectively. (5) These results suggest that the recovery of left atrial contractive function after surgical maze ablation is a dynamic improvement process. Early recovery of left atrial contractive function is beneficial to maintaining stable sinus rhythm in the future. Prolonged duration of atrial fibrillation, enlarged left atrial diameter, and cryoablation mode may have adverse effects on surgical maze ablation. Valve ring implantation or valvular replacement does not affect the efficacy of surgical maze ablation.

Key words:

atrial fibrillation, valvular heart disease, maze procedure, atrial contraction, biomaterial, material compatibility, artificial valve ring, , heart valve prosthesis

CLC Number:

Ma Chao, Wang Huishan, Han Jinsong, Yin Zongtao, Zhang Xiling.

Cardiac valve prosthesis implantation and surgical maze ablation for the treatment of valvular disease with atrial fibrillation [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(28): 4580-4587.

Figures/Tables 9

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