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.	胡盛壽, 高潤霖, 劉力生, 等. 《中國心血管病報告 2018 概要》. 中國循環雜志, 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.	楊力凡, 周達新. 老年退行性心臟瓣膜病發病機制的研究進展. 中華心血管病雜志, 2017, 45(10): 895-898.
8.	Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
9.	劉元生. 快速心房顫動的急診靜脈用藥治療. 中華心臟與心律電子雜志, 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, 黃曉燕, 等. 老年心臟瓣膜置換術合并冠狀動脈搭橋術患者同期進行房顫射頻消融術的療效觀察. 老年醫學與保健, 2019, 25(3): 315-318.
15.	肖雄, 韓勁松, 王輝山, 等. 冷凍消融迷宮術治療瓣膜病合并心房顫動的圍術期管理. 中國體外循環雜志, 2018, 16(1): 29-32.
16.	浮志坤, 張向立, 楊慧娟, 等. 瓣膜手術同期行心房顫動雙極射頻消融術早期臨床療效分析. 臨床醫學, 2018, 38(1): 55-57.
17.	徐輝, 葛建軍, 汪洋, 等. 心臟瓣膜置換同期行改良雙極房顫射頻消融術的安全性及有效性評價. 安徽醫學, 2019, 40(4): 381-384.
18.	袁占占, 熊敏, 徐海燕. 瓣膜置換術聯合射頻消融術治療心臟瓣膜病變合并房顫的療效觀察. 局解手術學雜志, 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.	鄭哲, 姚焰, 李浩杰, 等. 外科和介入復合治療難治性心房顫動初步經驗. 中國循環雜志, 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, 杜鵑, 宋云虎, 等. 單純冠狀動脈旁路移植術后新發心房顫動的危險因素分析. 中國胸心血管外科臨床雜志, 2019, 26(12): 1199-1203.
23.	徐昊, 楊懿人, 馬寧, 等. 射頻消融術聯合二尖瓣置換術對二尖瓣狹窄合并心房顫動患者的近期效果分析. 中國胸心血管外科臨床雜志, 2018, 25(9): 786-790.
24.	劉佳升, 張本貴, 肖正華, 等. 雙極射頻消融術治療風濕性心臟病合并心房顫動的對照研究. 中國胸心血管外科臨床雜志, 2017, 24(12): 923-931.

1. 胡盛壽, 高潤霖, 劉力生, 等. 《中國心血管病報告 2018 概要》. 中國循環雜志, 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. 楊力凡, 周達新. 老年退行性心臟瓣膜病發病機制的研究進展. 中華心血管病雜志, 2017, 45(10): 895-898.
8. Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
9. 劉元生. 快速心房顫動的急診靜脈用藥治療. 中華心臟與心律電子雜志, 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, 黃曉燕, 等. 老年心臟瓣膜置換術合并冠狀動脈搭橋術患者同期進行房顫射頻消融術的療效觀察. 老年醫學與保健, 2019, 25(3): 315-318.
15. 肖雄, 韓勁松, 王輝山, 等. 冷凍消融迷宮術治療瓣膜病合并心房顫動的圍術期管理. 中國體外循環雜志, 2018, 16(1): 29-32.
16. 浮志坤, 張向立, 楊慧娟, 等. 瓣膜手術同期行心房顫動雙極射頻消融術早期臨床療效分析. 臨床醫學, 2018, 38(1): 55-57.
17. 徐輝, 葛建軍, 汪洋, 等. 心臟瓣膜置換同期行改良雙極房顫射頻消融術的安全性及有效性評價. 安徽醫學, 2019, 40(4): 381-384.
18. 袁占占, 熊敏, 徐海燕. 瓣膜置換術聯合射頻消融術治療心臟瓣膜病變合并房顫的療效觀察. 局解手術學雜志, 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. 鄭哲, 姚焰, 李浩杰, 等. 外科和介入復合治療難治性心房顫動初步經驗. 中國循環雜志, 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, 杜鵑, 宋云虎, 等. 單純冠狀動脈旁路移植術后新發心房顫動的危險因素分析. 中國胸心血管外科臨床雜志, 2019, 26(12): 1199-1203.
23. 徐昊, 楊懿人, 馬寧, 等. 射頻消融術聯合二尖瓣置換術對二尖瓣狹窄合并心房顫動患者的近期效果分析. 中國胸心血管外科臨床雜志, 2018, 25(9): 786-790.
24. 劉佳升, 張本貴, 肖正華, 等. 雙極射頻消融術治療風濕性心臟病合并心房顫動的對照研究. 中國胸心血管外科臨床雜志, 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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