Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xinting ^1,2 , WANG Huishan ² ,  HAN Jinsong ² , YIN Zongtao ² , ZHANG Yingjie ² , LUO Yu ² , LIANG Hanqing ² , GUO Zhipeng ²

1. Graduate School, Jinzhou Medical University, Shenyang, 110016, P. R. China;
2. Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding?author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Cryoablation; Maze procedure; elderly patients; mitral valve disease; atrial fibrillation; propensity-score matching study

DOI：

10.7507/1007-4848.202011004

Video：

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Objective To evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.Methods From May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups.Results After PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05).Conclusion The mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.

Citation： CHEN Xinting, WANG Huishan, HAN Jinsong, YIN Zongtao, ZHANG Yingjie, LUO Yu, LIANG Hanqing, GUO Zhipeng. Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 748-754. doi: 10.7507/1007-4848.202011004 Copy

1.	Lip GYH, Collet JP, Caterina R, et al. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: A joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace, 2017, 19(11): 1757-1758.
2.	黃從新, 張澍, 黃德嘉, 等. 心房顫動: 目前的認識和治療建議(2018). 中國心律失常學雜志, 2018, 22(4): 279-344.
3.	Morin DP, Bernard ML, Madias C, et al. The state of the art: Atrial fibrillation epidemiology, prevention, and treatment. Mayo Clin Proc, 2016, 91(12): 1778-1810.
4.	Banerjee A, Allan V, Denaxas S, et al. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: Phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5.	Esteves AF, Brito D, Rigueira J, et al. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
6.	Ad N, Holmes SD, Massimiano PS, et al. Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2018, 155(3): 983-994.
7.	Wang H, Han J, Wang Z, et al. Efficacy of cut-and-sew surgical ablation for atrial fibrillation in patients with giant left atria undergoing mitral valve surgery: A propensity-matched analysis. Semin Thorac Cardiovasc Surg, 2019, 31(4): 796-802.
8.	韓勁松, 王輝山, 汪曾煒, 等. Cox迷宮Ⅲ型手術治療風濕性二尖瓣病變伴發心房顫動的安全性和有效性. 中華醫學雜志, 2016, 96(13): 1011-1015.
9.	韓勁松, 王輝山, 汪曾煒, 等. 傾向性評分法評價迷宮Ⅲ手術治療退行性二尖瓣病變合并房顫的安全性和療效. 中華胸心血管外科雜志, 2017, 33(8): 466-471.
10.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
11.	Curiel-Balsera E, Mora-Ordo?ez JM, Castillo-Lorente E, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care, 2013, 28(4): 397-404.
12.	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.
13.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
14.	Mizrahi EH, Fleissig Y, Arad M, et al. Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients. Arch Gerontol Geriatr, 2014, 58(1): 121-124.
15.	馬超, 王輝山, 韓勁松, 等. 瓣膜性心房顫動冷凍消融迷宮Ⅳ術后心房收縮功能恢復規律分析. 中國胸心血管外科臨床雜志, 2020, 27(9): 1045-1054.
16.	韓勁松, 王輝山, 尹宗濤, 等. 兩種人工瓣環置入修復單純二尖瓣環擴張引起的二尖瓣關閉不全的比較. 中國組織工程研究, 2015, 19(16): 2578-2582.
17.	Lombard FW, Liang Y. Risk factors for mitral valve surgery: Atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
18.	Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
19.	Ad N, Damiano RJ, Badhwar V, et al. Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(6): 1330-1354.
20.	Gomes GG, Gali WL, Sarabanda AVL, et al. Late results of Cox Maze Ⅲ procedure in patients with atrial fibrillation associated with structural heart disease. Arq Bras Cardiol, 2017, 109(1): 14-22.
21.	Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze Ⅳ procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(1): 159-170.
22.	Labin JE, Haque N, Sinn LA, et al. The Cox-Maze Ⅳ procedure for atrial fibrillation is equally efficacious in patients with rheumatic and degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2017, 154(3): 835-844.
23.	Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
24.	韓博, 于建波, 朱恩軍, 等. 高齡患者心臟瓣膜手術聯合冠狀動脈旁路移植術發生院內死亡的危險因素分析. 實用醫院臨床雜志, 2017, 14(2): 36-39.
25.	Hothi S, Tan D, MacDonald W, et al. Does intervention of severe valve lesions always improve cardiac function. Heart, 2015, 101(Suppl 4): A52-A53.
26.	Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitantCox-maze Ⅲ procedure using an argon-based cryosurgical system: A single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
27.	Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
28.	Arnaz A, Güllü Aü, Akyol A, et al. Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results. Turk Gogus Kalp Damar Cerrahisi Derg, 2018, 26(1): 8-13.
29.	Jeong DS, You JH, Jeon CS, et al. Impact of ablation duration on rhythm outcome after concomitant maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30.	Cai W, Hu J, Wang H, et al. Valve surgery in combination with cryoablation in the treatment of atrial fibrillation. Pak J Med Sci, 2018, 34(6): 1402-1407.

1. Lip GYH, Collet JP, Caterina R, et al. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: A joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace, 2017, 19(11): 1757-1758.
2. 黃從新, 張澍, 黃德嘉, 等. 心房顫動: 目前的認識和治療建議(2018). 中國心律失常學雜志, 2018, 22(4): 279-344.
3. Morin DP, Bernard ML, Madias C, et al. The state of the art: Atrial fibrillation epidemiology, prevention, and treatment. Mayo Clin Proc, 2016, 91(12): 1778-1810.
4. Banerjee A, Allan V, Denaxas S, et al. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: Phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5. Esteves AF, Brito D, Rigueira J, et al. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
6. Ad N, Holmes SD, Massimiano PS, et al. Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2018, 155(3): 983-994.
7. Wang H, Han J, Wang Z, et al. Efficacy of cut-and-sew surgical ablation for atrial fibrillation in patients with giant left atria undergoing mitral valve surgery: A propensity-matched analysis. Semin Thorac Cardiovasc Surg, 2019, 31(4): 796-802.
8. 韓勁松, 王輝山, 汪曾煒, 等. Cox迷宮Ⅲ型手術治療風濕性二尖瓣病變伴發心房顫動的安全性和有效性. 中華醫學雜志, 2016, 96(13): 1011-1015.
9. 韓勁松, 王輝山, 汪曾煒, 等. 傾向性評分法評價迷宮Ⅲ手術治療退行性二尖瓣病變合并房顫的安全性和療效. 中華胸心血管外科雜志, 2017, 33(8): 466-471.
10. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
11. Curiel-Balsera E, Mora-Ordo?ez JM, Castillo-Lorente E, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care, 2013, 28(4): 397-404.
12. 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.
13. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
14. Mizrahi EH, Fleissig Y, Arad M, et al. Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients. Arch Gerontol Geriatr, 2014, 58(1): 121-124.
15. 馬超, 王輝山, 韓勁松, 等. 瓣膜性心房顫動冷凍消融迷宮Ⅳ術后心房收縮功能恢復規律分析. 中國胸心血管外科臨床雜志, 2020, 27(9): 1045-1054.
16. 韓勁松, 王輝山, 尹宗濤, 等. 兩種人工瓣環置入修復單純二尖瓣環擴張引起的二尖瓣關閉不全的比較. 中國組織工程研究, 2015, 19(16): 2578-2582.
17. Lombard FW, Liang Y. Risk factors for mitral valve surgery: Atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
18. Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
19. Ad N, Damiano RJ, Badhwar V, et al. Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(6): 1330-1354.
20. Gomes GG, Gali WL, Sarabanda AVL, et al. Late results of Cox Maze Ⅲ procedure in patients with atrial fibrillation associated with structural heart disease. Arq Bras Cardiol, 2017, 109(1): 14-22.
21. Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze Ⅳ procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(1): 159-170.
22. Labin JE, Haque N, Sinn LA, et al. The Cox-Maze Ⅳ procedure for atrial fibrillation is equally efficacious in patients with rheumatic and degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2017, 154(3): 835-844.
23. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
24. 韓博, 于建波, 朱恩軍, 等. 高齡患者心臟瓣膜手術聯合冠狀動脈旁路移植術發生院內死亡的危險因素分析. 實用醫院臨床雜志, 2017, 14(2): 36-39.
25. Hothi S, Tan D, MacDonald W, et al. Does intervention of severe valve lesions always improve cardiac function. Heart, 2015, 101(Suppl 4): A52-A53.
26. Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitantCox-maze Ⅲ procedure using an argon-based cryosurgical system: A single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
27. Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
28. Arnaz A, Güllü Aü, Akyol A, et al. Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results. Turk Gogus Kalp Damar Cerrahisi Derg, 2018, 26(1): 8-13.
29. Jeong DS, You JH, Jeon CS, et al. Impact of ablation duration on rhythm outcome after concomitant maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30. Cai W, Hu J, Wang H, et al. Valve surgery in combination with cryoablation in the treatment of atrial fibrillation. Pak J Med Sci, 2018, 34(6): 1402-1407.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study

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