AIM: Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining the Maze III procedure with mitral valve surgery. METHODS:Thirty-five patients with AF and a mean age of 64 years undergoing mitral valve surgery were prospectively randomized according to a 2.5:1 ratio to surgery with (n=25), or without (n=10) maze III and followed for at least 1 year. RESULTS: At discharge and after 12 months freedom from AF was 56% and 92%, respectively, in the maze group, and 0% and 20%, respectively, in patients without maze (group differences at discharge p=0.002, after 12 months p=0.0007). Sinus node incompetence was seen in 1 of 25 maze patients requiring pacing. No in-hospital or late death occurred; stroke was observed in 1 patient (without maze). Quality of life markedly improved after surgery, but did not differ between patients with or without maze surgery. CONCLUSIONS: This first prospective randomized study shows that combining maze III with mitral valve surgery resulted in a significantly better elimination of preoperative AF than mitral valve surgery alone. As the quality of life did not differ between patients with, or without maze surgery, additional maze surgery is primarily recommended in patients in whom anticoagulation therapy can be avoided after surgery, specifically in patients with scheduled mitral valve plasty.
RCT Entities:
AIM: Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining the Maze III procedure with mitral valve surgery. METHODS: Thirty-five patients with AF and a mean age of 64 years undergoing mitral valve surgery were prospectively randomized according to a 2.5:1 ratio to surgery with (n=25), or without (n=10) maze III and followed for at least 1 year. RESULTS: At discharge and after 12 months freedom from AF was 56% and 92%, respectively, in the maze group, and 0% and 20%, respectively, in patients without maze (group differences at discharge p=0.002, after 12 months p=0.0007). Sinus node incompetence was seen in 1 of 25 maze patients requiring pacing. No in-hospital or late death occurred; stroke was observed in 1 patient (without maze). Quality of life markedly improved after surgery, but did not differ between patients with or without maze surgery. CONCLUSIONS: This first prospective randomized study shows that combining maze III with mitral valve surgery resulted in a significantly better elimination of preoperative AF than mitral valve surgery alone. As the quality of life did not differ between patients with, or without maze surgery, additional maze surgery is primarily recommended in patients in whom anticoagulation therapy can be avoided after surgery, specifically in patients with scheduled mitral valve plasty.
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: A Marc Gillinov; Michael Argenziano; Eugene H Blackstone; Alexander Iribarne; Joseph J DeRose; Gorav Ailawadi; Mark J Russo; Deborah D Ascheim; Michael K Parides; Evelio Rodriguez; Denis Bouchard; Wendy C Taddei-Peters; Nancy L Geller; Michael A Acker; Annetine C Gelijns Journal: J Thorac Cardiovasc Surg Date: 2011-05-25 Impact factor: 5.209
Authors: A Marc Gillinov; Annetine C Gelijns; Michael K Parides; Joseph J DeRose; Alan J Moskowitz; Pierre Voisine; Gorav Ailawadi; Denis Bouchard; Peter K Smith; Michael J Mack; Michael A Acker; John C Mullen; Eric A Rose; Helena L Chang; John D Puskas; Jean-Philippe Couderc; Timothy J Gardner; Robin Varghese; Keith A Horvath; Steven F Bolling; Robert E Michler; Nancy L Geller; Deborah D Ascheim; Marissa A Miller; Emilia Bagiella; Ellen G Moquete; Paula Williams; Wendy C Taddei-Peters; Patrick T O'Gara; Eugene H Blackstone; Michael Argenziano Journal: N Engl J Med Date: 2015-03-16 Impact factor: 91.245
Authors: Eugene H Blackstone; Helena L Chang; Jeevanantham Rajeswaran; Michael K Parides; Hemant Ishwaran; Liang Li; John Ehrlinger; Annetine C Gelijns; Alan J Moskowitz; Michael Argenziano; Joseph J DeRose; Jean-Phillipe Couderc; Dan Balda; François Dagenais; Michael J Mack; Gorav Ailawadi; Peter K Smith; Michael A Acker; Patrick T O'Gara; A Marc Gillinov Journal: J Thorac Cardiovasc Surg Date: 2018-07-27 Impact factor: 5.209
Authors: Anders Jönsson; Mika Lehto; Henrik Ahn; Ulf Hermansson; Peter Linde; Anders Ahlsson; Juhani Koistinen; Jukka Savola; Pekka Raatikainen; Martti Lepojärvi; Antero Sahlman; Kalervo Werkkala; Lauri Toivonen; Håkan Walfridsson Journal: J Atr Fibrillation Date: 2012-08-20
Authors: Mark D Huffman; Kunal N Karmali; Mark A Berendsen; Adin-Cristian Andrei; Jane Kruse; Patrick M McCarthy; S C Malaisrie Journal: Cochrane Database Syst Rev Date: 2016-08-22