The Impact of Mitral Valvular Etiology on Left Atrial Functional Recovery After the Maze Procedure: A Comparison Between Mitral Stenosis, Mitral Regurgitation and Non-Mitral Valve Disease

Q: What are the key findings of this study?

After the Maze procedure, patients with mitral regurgitation showed significantly better left atrial contractile recovery than those with mitral stenosis (p<0.05).

Q: What does this research mean for the field?

Mitral regurgitation (MR) leads to superior left atrial functional recovery compared to mitral stenosis (MS) after the Maze procedure, despite both groups achieving sinus rhythm. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

This research aims to evaluate the impact of different mitral valvular conditions on left atrial functional recovery following the Maze procedure.

Woo Sung Jang; Jung Woo; Kyungsub Song

doi:10.3390/jcm15051856

February 28, 2026Open Access

The Impact of Mitral Valvular Etiology on Left Atrial Functional Recovery After the Maze Procedure: A Comparison Between Mitral Stenosis, Mitral Regurgitation and Non-Mitral Valve Disease

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Key result

Maze procedure shows better LA contractile recovery in mitral regurgitation versus mitral stenosis.

p<0.05

Figures

Why the study?

It remained unclear whether electrical restoration from the Maze procedure translates into uniform left atrial functional recovery across different valvular etiologies.

Does mitral valvular etiology (mitral stenosis vs mitral regurgitation) impact left atrial functional recovery after the Maze procedure in patients maintaining sinus rhythm?

Key Points

This research aims to evaluate the impact of different mitral valvular conditions on left atrial functional recovery following the Maze procedure.
Conducted a retrospective study with 211 patients undergoing the Maze procedure with valvular surgery
Stratified patients into three groups: mitral stenosis (MS), mitral regurgitation (MR), and non-mitral disease
Evaluated left atrial function using speckle-tracking echocardiography at baseline, immediately after surgery, and at 1 year
At one year, non-mitral group had the best left atrial function, MR was better than MS
Both MS and MR showed similar improvements in passive stiffness, but MR had significantly better active contractile strain recovery
MS group did not regain effective atrial contraction despite successful rhythm control

Structured PICO

Does mitral valvular etiology (mitral stenosis vs mitral regurgitation) impact left atrial functional recovery after the Maze procedure in patients maintaining sinus rhythm?

P

Population

211 patients who underwent the Maze procedure concomitant with valvular surgery and maintained sinus rhythm after 1 year, stratified into mitral stenosis (n=51), mitral regurgitation (n=98), and non-mitral valve disease (n=62).

I

Intervention

Maze procedure concomitant with valvular surgery for mitral stenosis or mitral regurgitation

C

Comparator

Non-mitral valve disease reference group (n=62) and cross-comparison between mitral stenosis and mitral regurgitation

O

Outcome

Changes in LA reservoir (LASr), LA conduit (LAScd), and LA contractile (LASct) strains evaluated using speckle-tracking echocardiography at 1 yearsurrogate

Despite successful restoration of sinus rhythm after the Maze procedure, patients with mitral stenosis exhibit persistent left atrial mechanical dysfunction compared to those with mitral regurgitation.

Implication

May warrant LA function surveillance in MS despite SR after Maze; challenges consensus of uniform recovery versus MR.

Abstract

Background: Although the concomitant Maze procedure successfully restores sinus rhythm in patients with valvular atrial fibrillation, it remains unclear whether electrical restoration translates into uniform functional recovery across different valvular etiologies. To address this issue, we compared the long-term left atrial (LA) mechanical recovery between patients with mitral stenosis (MS) and mitral regurgitation (MR) after the Maze procedure. Methods: This retrospective study included 211 patients who underwent the Maze procedure concomitant with valvular surgery and maintained sinus rhythm after 1 year. Patients were stratified into three groups, namely MS (n = 51), MR (n = 98), and non-mitral (n = 62) serving as a reference. LA function was evaluated using speckle-tracking echocardiography at baseline, immediately postoperatively, and at 1 year. Primary outcomes were changes in LA reservoir (LASr), LA conduit (LAScd), and LA contractile (LASct) strains. Results: At 1-year follow-up, the non-mitral reference group exhibited the best LA function, followed by the MR group, whereas the MS group showed the most impaired values (p < 0.001). Analysis of functional recovery revealed a mechanistic divergence, i.e., although the improvement in passive stiffness (LAScd) was comparable between the MS and MR groups (p = 0.42), the recovery of active contractile strain (LASct) was significantly superior in the MR group compared to the MS group (p < 0.05). The MS group failed to regain effective atrial contraction despite successful rhythm control. Conclusions: Although the Maze procedure successfully restored sinus rhythm, functional recovery varied significantly by etiology. The superior recovery in patients with MR was driven by the restoration of active atrial contraction, whereas patients with MS exhibited persistent mechanical dysfunction attributed to irreversible myocardial structural remodeling, despite similar improvements in compliance. Therefore, electrical success does not guarantee functional success, particularly in patients with MS.

Discussion

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Cite This Study

Jang et al. (2026) studied this question. After the Maze procedure, patients with mitral regurgitation showed significantly better left atrial contractile recovery than those with mitral stenosis (p<0.05).

synapsesocial.com/papers/69a67eebf353c071a6f0a83d https://doi.org/10.3390/jcm15051856