Key result
The maze procedure combined with mitral valve surgery yielded comparable improvements in peak VO2 to surgery alone, with increased VO2 correlating with reduced left atrial diameter (r=-0.40, p=0.047).
Why the study?
Does the maze procedure combined with mitral valve surgery improve exercise capacity compared to mitral valve surgery alone in patients with atrial fibrillation and mitral valve disease?
Cohort (n=32)
No
Does the maze procedure combined with mitral valve surgery improve exercise capacity compared to mitral valve surgery alone in patients with atrial fibrillation and mitral valve disease?
Improvement in exercise capacity after mitral valve surgery with or without the maze procedure appears to be driven by reduction in left atrial size and hemodynamic improvement rather than restoration of sinus rhythm.
Maze adds no exercise capacity benefit to mitral valve surgery alone; supports left atrial reduction over sinus rhythm restoration as VO2 driver.
OBJECTIVE: To clarify the mechanism of improvement in exercise capacity after the maze procedure. DESIGN: Retrospective study. SETTING: Tertiary referral centre. PATIENTS: 26 patients (mean (SD) age 57 (9) years) with atrial fibrillation (AF) and mitral valve disease were studied with echocardiography and cardiopulmonary exercise testing before and after the maze procedure combined with mitral valve surgery. Of these, eight had persistent AF and 18 had restored sinus rhythm (SR) by the surgery. Six patients (mean (SD) age 59 (12) years) with AF undergoing mitral valve surgery without the maze procedure who had cardiopulmonary exercise testing before and after the surgery formed the control group. MAIN OUTCOME MEASURES: Echocardiographic parameters of atrial function were measured from transmitral flow recordings. Peak oxygen uptake (VO2) and the slope of the relation between VO2 and workload (ratio of DeltaVO2 to Delta work) were determined as indices of exercise capacity. RESULTS: The degree of improvements in peak VO2 and the ratio of DeltaVO2 to Delta work after the mitral valve surgery was comparable between the maze and control group. It was also comparable between patients with and those without successfully restored SR after the maze procedure. The degree of the increase in peak VO2 correlated with the change in left atrial diameter (r = -0.40, p = 0.047) but atrial contraction did not correlate with the increase. CONCLUSIONS: Improvement in exercise capacity may not be caused by restored SR and atrial contraction but may at least partly relate to the reduction of left atrial size and improvement of haemodynamic variables by the surgery.
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Satoshi Yuda (2003) conducted a cohort in Atrial fibrillation and mitral valve disease (n=32). Maze procedure combined with mitral valve surgery vs. Mitral valve surgery without the maze procedure was evaluated on Peak oxygen uptake (VO2) and the slope of the relation between VO2 and workload. The maze procedure combined with mitral valve surgery yielded comparable improvements in peak VO2 to surgery alone, with increased VO2 correlating with reduced left atrial diameter (r=-0.40, p=0.047).
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