Long-term outcomes of maze procedure plus valve replacement in treating rheumatic valve disease resulting in atrial fibrillation.

BACKGROUND: This study aimed to analyze the long-term results of mitral valve replacement and concomitant Cox-Maze III procedure (CMP) in treating rheumatic heart valve disease and associated permanent atrial fibrillation. Outcomes of CMP using a pure "cut-and-sew" method were assessed.

METHODS: Between 1995 and 2004, 60 patients received mechanical mitral (or mitral plus aortic) valve replacement and concomitant CMP. Among them, 22 underwent classic CMP that included five localized cryoablations, and 38 received a CMP without using cryoablations. All patients received periodic follow-up and oral anticoagulation therapy.

RESULTS: The demographic features of both groups of patients were comparable. A total of 65 mechanic valves were implanted. Operative data and in-hospital outcomes were insignificant except that the immediate sinus conversion rate was higher in the pure cut-and-sew group. At last follow-up, sinus rhythm was 81.1% in the pure cut-and-sew group (median, 112 months) and 72.7% in the classic CMP group (median, 113 months; p = 0.4541). Actuarial freedom from atrial fibrillation was also similar (5 years, 83.8% versus 76.8%; 10 years, 79.1% versus 70.4%; p = 0.6039). In both groups, the late results of left atrium size were significantly reduced, while the proportion of long-term tricuspid regurgitation was still remarkable.

CONCLUSIONS: Mitral valve replacement and concomitant CMP is effective in treating rheumatic valve disease and permanent atrial fibrillation with satisfactory results. A complete cut-and-sew method is technically practicable, and is as effective as the classic CMP in the long term.