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Eur J Cardiothorac Surg 2006;30:728-736
© 2006 Elsevier Science NL

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

^a Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
^b Division of Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea
^c Division of Cardiology and Electrophysiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea
^d Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Received 19 April 2006; received in revised form 24 August 2006; accepted 25 August 2006.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Guro Hospital, College of Medicine, Korea University, 80 Guro-Dong, Guro-Gu, Seoul 152-703, Republic of Korea. Tel.: +82 2 818 6073; fax: +82 2 818 6377. (Email: mdmjbaek{at}korea.ac.kr).

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.

Key Words: Atrial fibrillation • Arrhythmia surgery • Rheumatic • Mitral valve • Cryoablation

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