Optimal patient selection for maze procedure in patients undergoing mitral valve disease
Abstract Objectives Although risk factors for unsuccessful Maze procedure have been demonstrated, an appropriate patient selection is still controversial. In our institute, Maze procedure is indicated for those whom normal sinus rhythm (NSR) was reestablished by intraoperative direct cardioversion (...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02766-z |
| _version_ | 1797209064998961152 |
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| author | Tomoaki Masuda Atsushi Aoki Tadashi Omoto Kazuto Maruta |
| author_facet | Tomoaki Masuda Atsushi Aoki Tadashi Omoto Kazuto Maruta |
| author_sort | Tomoaki Masuda |
| collection | DOAJ |
| description | Abstract Objectives Although risk factors for unsuccessful Maze procedure have been demonstrated, an appropriate patient selection is still controversial. In our institute, Maze procedure is indicated for those whom normal sinus rhythm (NSR) was reestablished by intraoperative direct cardioversion (DC) after ventricular unloading by total cardiopulmonary bypass. The purpose of this study was to evaluate the effectiveness of our indication criteria for Maze procedure in patients with mitral valve disease. Methods Between October 2012 and October 2021, MAZE was indicated in 55 patients in whom normal sinus rhythm (NSR) was reestablished by intraoperative direct current cardioversion (DC). Three endpoints and predictors were examined: disappearance of atrial fibrillation (AF), NSR, and A-wave detection. Results Restoration of NSR by intraoperative DC was confirmed in 43 patients, and these patients underwent MAZE. AF disappeared in 39 patients (90.7%), and F-wave ≥ 0.1 mV was a significant predictive factor (odds ratio (OR) 20.99, 95% CI 1.22–1079.06). NSR was reestablished in 36 patients (83.7%), and F-wave ≥ 0.1 mV (odds ratio 15.62, 95% CI 1.62–359.86) + AF history ≤ 3 years (OR 8.30, 95% CI 1.09–177.04) were significant predictors. A-wave detection was confirmed in 26 patients (60.5%), and left atrial diameter ≤ 55 mm was a significant predictor (OR 5.22, 95% CI 1.28–24.79). Conclusions Intraoperative DC after ventricular unloading resulted effective patient selection for concomitant Maze procedure. F-wave and AF history were predictive factor of electrical restoration of AF, and left atrial diameter was predictive factor of restoration of atrial function. |
| first_indexed | 2024-04-24T09:48:46Z |
| format | Article |
| id | doaj.art-786188641baf4c899fb8c54fbc8419b3 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T09:48:46Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-786188641baf4c899fb8c54fbc8419b32024-04-14T11:28:56ZengBMCJournal of Cardiothoracic Surgery1749-80902024-04-011911610.1186/s13019-024-02766-zOptimal patient selection for maze procedure in patients undergoing mitral valve diseaseTomoaki Masuda0Atsushi Aoki1Tadashi Omoto2Kazuto Maruta3Department of Cardiovascular Surgery, Showa UniversityDepartment of Cardiovascular Surgery, Showa UniversityDepartment of Cardiovascular Surgery, Showa UniversityDepartment of Cardiovascular Surgery, Showa UniversityAbstract Objectives Although risk factors for unsuccessful Maze procedure have been demonstrated, an appropriate patient selection is still controversial. In our institute, Maze procedure is indicated for those whom normal sinus rhythm (NSR) was reestablished by intraoperative direct cardioversion (DC) after ventricular unloading by total cardiopulmonary bypass. The purpose of this study was to evaluate the effectiveness of our indication criteria for Maze procedure in patients with mitral valve disease. Methods Between October 2012 and October 2021, MAZE was indicated in 55 patients in whom normal sinus rhythm (NSR) was reestablished by intraoperative direct current cardioversion (DC). Three endpoints and predictors were examined: disappearance of atrial fibrillation (AF), NSR, and A-wave detection. Results Restoration of NSR by intraoperative DC was confirmed in 43 patients, and these patients underwent MAZE. AF disappeared in 39 patients (90.7%), and F-wave ≥ 0.1 mV was a significant predictive factor (odds ratio (OR) 20.99, 95% CI 1.22–1079.06). NSR was reestablished in 36 patients (83.7%), and F-wave ≥ 0.1 mV (odds ratio 15.62, 95% CI 1.62–359.86) + AF history ≤ 3 years (OR 8.30, 95% CI 1.09–177.04) were significant predictors. A-wave detection was confirmed in 26 patients (60.5%), and left atrial diameter ≤ 55 mm was a significant predictor (OR 5.22, 95% CI 1.28–24.79). Conclusions Intraoperative DC after ventricular unloading resulted effective patient selection for concomitant Maze procedure. F-wave and AF history were predictive factor of electrical restoration of AF, and left atrial diameter was predictive factor of restoration of atrial function.https://doi.org/10.1186/s13019-024-02766-zMAZEMitral Valve SurgeryAtrial FibrillationPredictors |
| spellingShingle | Tomoaki Masuda Atsushi Aoki Tadashi Omoto Kazuto Maruta Optimal patient selection for maze procedure in patients undergoing mitral valve disease Journal of Cardiothoracic Surgery MAZE Mitral Valve Surgery Atrial Fibrillation Predictors |
| title | Optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| title_full | Optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| title_fullStr | Optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| title_full_unstemmed | Optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| title_short | Optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| title_sort | optimal patient selection for maze procedure in patients undergoing mitral valve disease |
| topic | MAZE Mitral Valve Surgery Atrial Fibrillation Predictors |
| url | https://doi.org/10.1186/s13019-024-02766-z |
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