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Eur J Cardiothorac Surg 1998;13:247-252
© 1998 Elsevier Science NL

Improved success rate of the maze procedure in mitral valve disease by new criteria for patients’ selection¹

The Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita-city, Osaka 565, Japan

Received 29 September 1997; received in revised form 8 December 1997; accepted 16 December 1997.

Corresponding author. Tel.: +81 6 8335012; fax: +81 6 8727486; e-mail: jkobayas@hosp.ncvc.go.jp

Objective: We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively. Methods: Between May 1992 and February 1997, we carried out the maze procedure in 220 patients as a combined operation with mitral valve surgery. During period 2, we carried out the maze procedure in 63 cases who satisfied all the new criteria (voltage of f-wave in V1 lead >0.1 mV, cardiothoracic ratio (CTR) <70%, LA dimension <70 mm), and 37 patients out of these criteria. Success was defined as sinus rhythm restoration without sick sinus syndrome. Results: There were 4 hospital deaths (1.8%) and 4 late deaths (1.8%). Success rate was significantly (P=0.0089) higher in period 2 (82%) than in period 1 (65%). Success rate was significantly higher in patients within criteria than out of criteria both in period 1, period 2, and total (77 versus 48%, P=0.018; 90 versus 66%, P=0.004, and 83 versus 55%, P=0.0001). Conclusion: The maze procedure is highly reliable when combined with mitral valve surgery if patients are selected properly.

Key Words: Atrial fibrillation • Maze procedure • Mitral valve disease

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