Left atrial maze efficacy for treatment of concomitant atrial fibrillation with mitral valve disease

ObjectiveThis study aims to compare the efficacy of mitral valve surgery with left atrial maze versus isolated mitral valve surgery.BackgroundAtrial fibrillation (AF) is the most common arrhythmia in clinical practice, especially with mitral valve disease. It represents a significant health burden especially with the associated thromboembolic complications. Several surgical approaches have been developed. The most effective one is Cox-Maze III procedure using cut-and-sew technique. Recently, surgical ablation has been transformed into an easier and faster procedure using radiofrequency, microwave, and cryothermal energy.Patients and methodsThis is a prospective cohort study conducted after the approval of the Human Ethics Committee of Faculty of Medicine, Menoufia University. A total of 100 patients with permanent AF and concomitant mitral valve disease have been recruited. The patients were allocated into two equal groups. Group A included mitral valve surgery and left atrial maze procedure, whereas group B included mitral valve surgery without left atrial maze.ResultsGroup A had significant longer bypass and clamp times than group B (P < 0.001). Group A had significant less postoperative AF as assessed at '1 week, 1 months, 3 months, and 6 months'. At 6 months, 74% of patients in group A were in sinus rhythm as compared with 20% of patients in group B (P < 0.0001). Moreover, it was noticed that 74% of patients in group A had atrial kick postoperatively as opposed to only 20% of patients in group B (P < 0.0001).ConclusionLeft atrial maze with mitral valve surgery results in a better outcome in terms of myocardial function and dimensions. In addition, sinus rhythm restoration has the potential benefit of reducing the incidence of thromboembolic complications.