Maze <b>Ⅳ</b> in the treatment of heart valve disease with persistent atrial fibrillation in elderly patients: A cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 FU Zhikun , YANG Huijuan , ZHANG Xiangli , ZHANG Shuguang , YANG Heng , ZHU Yongfeng , DU Peng

Department of Cardiac Surgery, The Seventh People's Hospital of Zhengzhou, Cardiovascular Disease Hospital of Zhengzhou, Zhengzhou, 450012, P.R.China;

Corresponding author：

FU Zhikun, Email: fuzhikun@126.com

Keywords：

Maze Ⅳ surgery; valvular heart disease; persistent atrial fibrillation; elderly patients

DOI：

10.7507/1007-4848.202002046

Video：

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Objective To investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF).Methods We retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared.Results There was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05).Conclusion Maze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.

Citation： FU Zhikun, YANG Huijuan, ZHANG Xiangli, ZHANG Shuguang, YANG Heng, ZHU Yongfeng, DU Peng. Maze Ⅳ in the treatment of heart valve disease with persistent atrial fibrillation in elderly patients: A cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1413-1417. doi: 10.7507/1007-4848.202002046 Copy

1.	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018 概要》. 中国循环杂志, 2019, 34(3): 209-220.
2.	Wang Z, Chen Z, Wang X, et al. The disease burden of atrial fibrillation in China from a national cross-sectional survey. Am J Cardiol, 2018, 122(5): 793-798.
3.	Masuda M, Fujita M, Iida O, et al. Association between local bipolar voltage and conduction gap along the left atrial linear ablation lesion in patients with atrial fibrillation. Am J Cardiol, 2017, 120(3): 408-413.
4.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): 1159-1195.
5.	Koh LY, Hwang NC. Frailty in cardiac surgery. J Cardiothorac Vasc Anesth, 2019, 33(2): 521-531.
6.	Kim WK, Kim HJ, Kim JB, et al. Clinical outcomes in 1 731 patients undergoing mitral valve surgery for rheumatic valve disease. Heart, 2018, 104(10): 841-848.
7.	杨力凡, 周达新. 老年退行性心脏瓣膜病发病机制的研究进展. 中华心血管病杂志, 2017, 45(10): 895-898.
8.	Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
9.	刘元生. 快速心房颤动的急诊静脉用药治疗. 中华心脏与心律电子杂志, 2017, 5(2): 70-73.
10.	Kalla M, Sanders P, Kalman JM, et al. Radiofrequency catheter ablation for atrial fibrillation: approaches and outcomes. Heart Lung Circ, 2017, 26(9): 941-949.
11.	Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: The CABANA Randomized Clinical Trial. JAMA, 2019, 321(13): 1261-1274.
12.	Iwasawa J, Koruth JS, Petru J, et al. Temperature-controlled radiofrequency ablation for pulmonary vein isolation in patients with atrial fibrillation. J Am Coll Cardiol, 2017, 70(5): 542-553.
13.	Badhwar V, Rankin JS, Damiano RJ Jr, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
14.	王沙, 王惠君, 黄晓燕, 等. 老年心脏瓣膜置换术合并冠状动脉搭桥术患者同期进行房颤射频消融术的疗效观察. 老年医学与保健, 2019, 25(3): 315-318.
15.	肖雄, 韩劲松, 王辉山, 等. 冷冻消融迷宫术治疗瓣膜病合并心房颤动的围术期管理. 中国体外循环杂志, 2018, 16(1): 29-32.
16.	浮志坤, 张向立, 杨慧娟, 等. 瓣膜手术同期行心房颤动双极射频消融术早期临床疗效分析. 临床医学, 2018, 38(1): 55-57.
17.	徐辉, 葛建军, 汪洋, 等. 心脏瓣膜置换同期行改良双极房颤射频消融术的安全性及有效性评价. 安徽医学, 2019, 40(4): 381-384.
18.	袁占占, 熊敏, 徐海燕. 瓣膜置换术联合射频消融术治疗心脏瓣膜病变合并房颤的疗效观察. 局解手术学杂志, 2018, 27(8): 558-561.
19.	Van Laar C, Kelder J, Van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg, 2017, 24(1): 204-213.
20.	郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
21.	Albage A, Sartipy U, Kenneback G, et al. Long-term risk of ischemic stroke after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2017, 104(2): 523-529.
22.	李琦, 杜鹃, 宋云虎, 等. 单纯冠状动脉旁路移植术后新发心房颤动的危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1199-1203.
23.	徐昊, 杨懿人, 马宁, 等. 射频消融术联合二尖瓣置换术对二尖瓣狭窄合并心房颤动患者的近期效果分析. 中国胸心血管外科临床杂志, 2018, 25(9): 786-790.
24.	刘佳升, 张本贵, 肖正华, 等. 双极射频消融术治疗风湿性心脏病合并心房颤动的对照研究. 中国胸心血管外科临床杂志, 2017, 24(12): 923-931.

1. 胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018 概要》. 中国循环杂志, 2019, 34(3): 209-220.
2. Wang Z, Chen Z, Wang X, et al. The disease burden of atrial fibrillation in China from a national cross-sectional survey. Am J Cardiol, 2018, 122(5): 793-798.
3. Masuda M, Fujita M, Iida O, et al. Association between local bipolar voltage and conduction gap along the left atrial linear ablation lesion in patients with atrial fibrillation. Am J Cardiol, 2017, 120(3): 408-413.
4. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): 1159-1195.
5. Koh LY, Hwang NC. Frailty in cardiac surgery. J Cardiothorac Vasc Anesth, 2019, 33(2): 521-531.
6. Kim WK, Kim HJ, Kim JB, et al. Clinical outcomes in 1 731 patients undergoing mitral valve surgery for rheumatic valve disease. Heart, 2018, 104(10): 841-848.
7. 杨力凡, 周达新. 老年退行性心脏瓣膜病发病机制的研究进展. 中华心血管病杂志, 2017, 45(10): 895-898.
8. Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
9. 刘元生. 快速心房颤动的急诊静脉用药治疗. 中华心脏与心律电子杂志, 2017, 5(2): 70-73.
10. Kalla M, Sanders P, Kalman JM, et al. Radiofrequency catheter ablation for atrial fibrillation: approaches and outcomes. Heart Lung Circ, 2017, 26(9): 941-949.
11. Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: The CABANA Randomized Clinical Trial. JAMA, 2019, 321(13): 1261-1274.
12. Iwasawa J, Koruth JS, Petru J, et al. Temperature-controlled radiofrequency ablation for pulmonary vein isolation in patients with atrial fibrillation. J Am Coll Cardiol, 2017, 70(5): 542-553.
13. Badhwar V, Rankin JS, Damiano RJ Jr, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
14. 王沙, 王惠君, 黄晓燕, 等. 老年心脏瓣膜置换术合并冠状动脉搭桥术患者同期进行房颤射频消融术的疗效观察. 老年医学与保健, 2019, 25(3): 315-318.
15. 肖雄, 韩劲松, 王辉山, 等. 冷冻消融迷宫术治疗瓣膜病合并心房颤动的围术期管理. 中国体外循环杂志, 2018, 16(1): 29-32.
16. 浮志坤, 张向立, 杨慧娟, 等. 瓣膜手术同期行心房颤动双极射频消融术早期临床疗效分析. 临床医学, 2018, 38(1): 55-57.
17. 徐辉, 葛建军, 汪洋, 等. 心脏瓣膜置换同期行改良双极房颤射频消融术的安全性及有效性评价. 安徽医学, 2019, 40(4): 381-384.
18. 袁占占, 熊敏, 徐海燕. 瓣膜置换术联合射频消融术治疗心脏瓣膜病变合并房颤的疗效观察. 局解手术学杂志, 2018, 27(8): 558-561.
19. Van Laar C, Kelder J, Van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg, 2017, 24(1): 204-213.
20. 郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
21. Albage A, Sartipy U, Kenneback G, et al. Long-term risk of ischemic stroke after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2017, 104(2): 523-529.
22. 李琦, 杜鹃, 宋云虎, 等. 单纯冠状动脉旁路移植术后新发心房颤动的危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1199-1203.
23. 徐昊, 杨懿人, 马宁, 等. 射频消融术联合二尖瓣置换术对二尖瓣狭窄合并心房颤动患者的近期效果分析. 中国胸心血管外科临床杂志, 2018, 25(9): 786-790.
24. 刘佳升, 张本贵, 肖正华, 等. 双极射频消融术治疗风湿性心脏病合并心房颤动的对照研究. 中国胸心血管外科临床杂志, 2017, 24(12): 923-931.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Maze Ⅳ in the treatment of heart valve disease with persistent atrial fibrillation in elderly patients: A cohort study

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