Concomitant maze procedure during mechanical valve replacement significantly reduced thromboembolic events (HR 0.29; 95% CI 0.12-0.73; P=0.008) compared with valve replacement alone.
Cohort (n=569)
Does a concomitant maze procedure reduce adverse outcomes in patients with atrial fibrillation undergoing mechanical valve replacement?
The addition of a maze procedure during mechanical valve replacement in patients with atrial fibrillation significantly reduces long-term thromboembolic complications and improves hemodynamic performance, particularly in low-risk surgical patients.
Estimación del efecto: HR 0.29 (95% CI 0.12-0.73)
valor p: p=0.008
BACKGROUND: The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear. METHODS AND RESULTS: We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation-associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65-2.03; P=0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50-1.34; P=0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12-0.73; P=0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2-149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0-3) subgroup (P=0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup (P=0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular (P<0.001) and tricuspid valvular functions (P<0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0-146.8 months) after surgery. CONCLUSION: Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.
Kim et al. (Wed,) conducted a cohort in atrial fibrillation-associated valvular heart disease (n=569). Concomitant maze procedure vs. Valve replacement alone was evaluated on thromboembolic events (HR 0.29, 95% CI 0.12-0.73, p=0.008). Concomitant maze procedure during mechanical valve replacement significantly reduced thromboembolic events (HR 0.29; 95% CI 0.12-0.73; P=0.008) compared with valve replacement alone.