What does this research mean for the field?

The Cryo-Maze procedure yields comparable 3-year freedom from sustained atrial fibrillation and requires significantly shorter cardiopulmonary bypass and aortic cross-clamp times compared to the conventional maze procedure in patients with mitral valve disease. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the early and intermediate-term clinical outcomes of a cryoablation-assisted maze procedure compared with the conventional cut-and-sew maze procedure in patients with mitral valve disease.

September 24, 2002Circulation

The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation associated with mitral valve disease (n=220). Intervention: Cryo-Maze procedure (CM) vs. Conventional (Kosakai) maze procedure (KM). Primary outcome: Actuarial freedom from recurrence of sustained atrial fibrillation at 3 years (p=0.11).

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Key result

The Cryo-Maze procedure yielded comparable 3-year freedom from sustained atrial fibrillation (97.7% vs 90.4%, P=0.11) and shorter cardiopulmonary bypass times compared to the conventional maze.

Why the study?

Does the cryo-maze procedure improve procedural times and maintain comparable sinus rhythm restoration compared to the conventional maze procedure in patients with atrial fibrillation associated with mitral valve disease?

Population

220 patients with atrial fibrillation associated with mitral valve disease, matched for age, left atrial…

Comparison

Maze procedure including pulmonary venous… vs Conventional maze procedure including encircling…

Design

Cohort

Follow-up

3 years

Authors

HNHiroyuki NakajimaNational Cerebral and Cardiovascular Center JKJunjiro KobayashiCardiac Surgery KBKo BandoJikei University School of Medicine

Discussion

Member takes

Implication

Cryo-Maze may shorten bypass times with comparable AF freedom; leaves open whether it should replace conventional maze pending randomized trials.

Key Points

To evaluate the early and intermediate-term clinical outcomes of a cryoablation-assisted maze procedure compared with the conventional cut-and-sew maze procedure in patients with mitral valve disease.
Case-matched comparative study evaluating 110 matched pairs of patients receiving either cryoablation maze (CM) or conventional Kosakai maze (KM).
Pairs were matched by age, left atrial dimension >70 mm, duration of atrial fibrillation, prior cardiac surgery, mechanical valve implantation, and concomitant aortic valve procedures.
Cryo-maze significantly shortened cardiopulmonary bypass time (186±56 vs. 214±47 min, P=0.001) and aortic cross-clamp time (134±43 vs. 144±37 min, P=0.03) while reducing 12-hour chest tube drainage (590±353 vs. 745±618 mL, P=0.02).
Sinus rhythm restoration at discharge was 85.4% in the CM group and 86.4% in the KM group.
Actuarial freedom from recurrent sustained atrial fibrillation at 3 years was 97.7% for CM versus 90.4% for KM (P=0.11), with 99.0% 3-year freedom from stroke in the CM group.

Study Design

Type

Cohort (n=220)

Structured PICO

Population

220 patients (110 pairs) with atrial fibrillation associated with mitral valve disease, matched for age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation, and concomitant aortic valve procedures.

Intervention

Maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM)

Comparator

Conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins

Outcome

Early and intermediate-term results including cardiopulmonary bypass time, aortic cross-clamp time, chest tube drainage, sinus rhythm restoration rate at discharge, and freedom from recurrence of sustained AF at 3 years

Main Result

Absolute Event Rate: 97.7% vs 90.4%

p-value: p=0.11

The cryo-maze procedure offers a less invasive surgical option with shorter procedural times and comparable sinus rhythm maintenance compared to the conventional maze procedure for patients with atrial fibrillation and mitral valve disease.

Cite This Study

Nakajima et al. (2002) conducted a cohort in Atrial fibrillation associated with mitral valve disease (n=220). Cryo-Maze procedure (CM) vs. Conventional (Kosakai) maze procedure (KM) was evaluated on Actuarial freedom from recurrence of sustained atrial fibrillation at 3 years (p=0.11). The Cryo-Maze procedure yielded comparable 3-year freedom from sustained atrial fibrillation (97.7% vs 90.4%, P=0.11) and shorter cardiopulmonary bypass times compared to the conventional maze.

synapsesocial.com/papers/6a154aef5347fbb1739f8b94 https://doi.org/10.1161/01.cir.0000032883.55215.49

Topics

Atrial fibrillation Persistent AF management Valvular heart disease AF ablation outcomes

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Implication

Cryo-Maze may shorten bypass times with comparable AF freedom; leaves open whether it should replace conventional maze pending randomized trials.

The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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