Long-Term Results of Atrial Fibrillation Surgery with Mitral Valvular Disease

Chang, Byung Chul; Maeng, Dae Hyeon; Kang, Jung Han; Cho, Sang Ho

Abstract

BACKGROUND: With mitral valvular heart disease, chronic atrial fibrillation(AF) is not likely to return to sinus rhythm after the operation. We evaluate the long term results and factors in recurrence of AF after modified Maze operation with mitral valve surgery. MATERIAL AND METHOD: From 1990 to 1996, 35 patients with chronic AF underwent modified Maze operation with mitral valve procedure in patients with chronic AF. The mean duration of AF was 7.7 +/-4.5 years. The concomitant operations were 34 mitral valve replacement(with 4 tricuspid annuloplasty and 3 tricuspid valve replacement)and 1 mitral valve repair. We analyzed the long term results and factors in recurrence of AF. RESULT: At immediate postoperatively, 33 of the 35 patients(93.9%) were converted to sinus rhythm. There was one operative death. However, AF recurred in 12 out of 35 patients during hospitalization and AF in these 12 patients were treated with antiarrhythmic drugs and electrical defibrillation 2-3 months later. Two out of twelve patients were failed in conversion to sinus rhythm after cessation of medication with side effects. During follow-up(71.1 +/-17.5 months, range 3-9 years), AF recurred in 9 patients and overall conversion rate to sinus rhythm was 73.5%. Predictors of postoperative AF included: duration of preoperative AF(maintenance group: recurrence group=6.3 years VS. 10.3 years, p=0.008) and cardiothoracic ratio on preoperative chest X-ray(0.58 VS. 0.72, p=0.009).
CONCLUSION
AF surgery with mitral valve procedure increase the chance of recovery into sinus rhythm, reduce the incidence of atrial arrhythmia, and reduce the left atrial size with decreasing wall stress simultaneously. In order to decrease the incidence of postoperative arrhythmia, proper modification of the surgery with medical therapy should be considered.