Effect of pulmonary hypertension on clinical efficacy of Cox Maze <b>Ⅳ</b> procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Wei ,  ZHANG Chengxin , GE Shenglin , LI Ran , GONG Wenhui , CHEN Tao

Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, P.R.China;

Corresponding author：

ZHANG Chengxin, Email: 734928334@qq.com

Keywords：

Atrial fibrillation; Maze operation; heart valve disease; surgery

DOI：

10.7507/1007-4848.202007087

Video：

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Objective To explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease.Methods The clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hgin all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed.Results (1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)].Conclusion PAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.

Citation： LI Wei, ZHANG Chengxin, GE Shenglin, LI Ran, GONG Wenhui, CHEN Tao. Effect of pulmonary hypertension on clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1432-1435. doi: 10.7507/1007-4848.202007087 Copy

1.	Cohn LH, Couper GS, Aranki SF, et al. Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve. J Thorac Cardiovasc Surg, 1994, 107(1): 143-150.
2.	Fukuda Y, Yoshida T, Inage T, et al. Long-term results of the Maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels, 2012, 27(1): 53-57.
3.	Kim JB, Ju MH, Yun SC, et al. Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation. Heart, 2010, 96(14): 1126-1131.
4.	Kim KC, Cho KR, Kim YJ, et al. Long-term results of the Cox-Maze Ⅲprocedure for persistent atrial fibrillation associated with rheumatic mitral valve disease: 10-year experience. Eur J Cardiothorac Surg, 2007, 31(2): 261-266.
5.	Benussi S, Pappone C, Nascimbene S, et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery: The epicardial radiofrequency approach. Eur J Cardiothorac Surg, 2000, 17(5): 524-529.
6.	张燕群. 肺动脉高压与阵发性心房颤动射频消融术后晚期复发的相关性. 福建医科大学, 2017.
7.	Goudis CA. Chronic obstructive pulmonary disease and atrial fibrillation: An unknown relationship. J Cardiol, 2017, 69(5): 699-705.
8.	Utsunomiya H, Itabashi Y, Mihara H, et al. Functional tricuspid regurgitation caused by chronic atrial fibrillation: A real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging, 2017, 10(1): e004897.
9.	Lau DH, Linz D, Sanders P. New findings in atrial fibrillation mechanisms. Card Electrophysiol Clin, 2019, 11(4): 563-571.
10.	Kobayashi T, Komiya T, Tamura N, et al. Long-term result of the Maze procedure for atrial fibrillation. Kyobu Geka, 2010, 63(4): 271-275.
11.	Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified Cox-Maze procedure for elderly patients: A risk analysis for failure. Interact Cardiovasc Thorac Surg, 2011, 12(6): 924-928.
12.	Scherf D. Studies on auricular tachycardia caused by aconitine administration. Proc Soc Exp Biol Med, 1947, 64(2): 233-239.
13.	丁树盛, 靖文斌, 张荣华. 肺静脉隔离术治疗慢性房颤的临床应用. 中国医学创新, 2019, 16(33): 24-27.
14.	Tongers J, Schwerdtfeger B, Klein G, et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J, 2007, 153(1): 127-132.
15.	McCarthy P, Szlapka M, Kruse J, et al. The relationship of atrial fibrillation and tricuspid annular dilation to late tricuspid regurgitation in patients with degenerative mitral repair. J Thorac Cardiovasc Surg, 2021, 161(6): 2030-2040.e3.
16.	Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 2007, 146(12): 857-867.

1. Cohn LH, Couper GS, Aranki SF, et al. Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve. J Thorac Cardiovasc Surg, 1994, 107(1): 143-150.
2. Fukuda Y, Yoshida T, Inage T, et al. Long-term results of the Maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels, 2012, 27(1): 53-57.
3. Kim JB, Ju MH, Yun SC, et al. Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation. Heart, 2010, 96(14): 1126-1131.
4. Kim KC, Cho KR, Kim YJ, et al. Long-term results of the Cox-Maze Ⅲprocedure for persistent atrial fibrillation associated with rheumatic mitral valve disease: 10-year experience. Eur J Cardiothorac Surg, 2007, 31(2): 261-266.
5. Benussi S, Pappone C, Nascimbene S, et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery: The epicardial radiofrequency approach. Eur J Cardiothorac Surg, 2000, 17(5): 524-529.
6. 张燕群. 肺动脉高压与阵发性心房颤动射频消融术后晚期复发的相关性. 福建医科大学, 2017.
7. Goudis CA. Chronic obstructive pulmonary disease and atrial fibrillation: An unknown relationship. J Cardiol, 2017, 69(5): 699-705.
8. Utsunomiya H, Itabashi Y, Mihara H, et al. Functional tricuspid regurgitation caused by chronic atrial fibrillation: A real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging, 2017, 10(1): e004897.
9. Lau DH, Linz D, Sanders P. New findings in atrial fibrillation mechanisms. Card Electrophysiol Clin, 2019, 11(4): 563-571.
10. Kobayashi T, Komiya T, Tamura N, et al. Long-term result of the Maze procedure for atrial fibrillation. Kyobu Geka, 2010, 63(4): 271-275.
11. Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified Cox-Maze procedure for elderly patients: A risk analysis for failure. Interact Cardiovasc Thorac Surg, 2011, 12(6): 924-928.
12. Scherf D. Studies on auricular tachycardia caused by aconitine administration. Proc Soc Exp Biol Med, 1947, 64(2): 233-239.
13. 丁树盛, 靖文斌, 张荣华. 肺静脉隔离术治疗慢性房颤的临床应用. 中国医学创新, 2019, 16(33): 24-27.
14. Tongers J, Schwerdtfeger B, Klein G, et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J, 2007, 153(1): 127-132.
15. McCarthy P, Szlapka M, Kruse J, et al. The relationship of atrial fibrillation and tricuspid annular dilation to late tricuspid regurgitation in patients with degenerative mitral repair. J Thorac Cardiovasc Surg, 2021, 161(6): 2030-2040.e3.
16. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 2007, 146(12): 857-867.

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Effect of pulmonary hypertension on clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study

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