The Efficacy Of Left-sided Maze Procedure During Robotic Mitral Valve Repair; The Mayo Clinic Experience
Lucman A. Anwer, Amit Taggarse, Hakan Akbayrak, Maurice E. Sarano, Hector I. Michelena, Joseph A. Dearani, Richard C. Daly, Simon Maltais.
Mayo Clinic, Rochester, MN, USA.
Objectives: Atrial fibrillation (AF) is common in patients with degenerative mitral valve disease. With a growing interest towards robotic mitral valve repair (MVr) surgery, attempts have been made to concomitantly address rhythm anomalies. We report outcomes of a left-sided MAZE (LSM) procedure for AF in patients undergoing robotic MVr.
Methods: From January 2008 to September 2016, 603 patients underwent robotic MVr for severe degenerative mitral regurgitation (MR). Medical records of 576 consenting patients were retrospectively reviewed to evaluate the efficiency of a LSM procedure. We analyzed rhythm outcomes with detailed postoperative echocardiogram findings including ejection fraction, recurrent MR, and residual gradient.
Results: A total of 55 patients out of 576 were identified as having preoperative AF, 9 were defined as persistent and 46 as paroxysmal. Of these, 39/55 underwent LSM procedure; 8/9 patients in persistent AF were part of this cohort. Postoperatively, 15.4%(6/39) of patients in the LSM cohort had AF, compared to 31.3%(5/16) in the non-LSM cohort, p=0.27. The postoperative incidence of new-onset AF in a control group of patients with preoperative sinus rhythm (SR) was 19.1%. Over 1 year of follow-up, freedom from AF was 95.7%(22/23) in the LSM group vs. 83.3%(5/6) in the non-LSM group. Early MVr outcomes demonstrated recurrent MR (moderate or greater) in 2%(12/575) of patients. While univariate analysis failed to reveal a correlation between preoperative AF and postoperative MR grade, left atrial volume index and pulmonary artery systolic pressures were risk factors for early recurrent MR.
Conclusions: Postoperative AF is common in patients undergoing robotic MVr. In patients with preoperative AF, a left-sided MAZE procedure effectively restores SR and may reduce the incidence of postoperative AF. While a concomitant LSM procedure effectively restores SR, a majority of patients will convert to SR overtime. AF does not portend increased risk of recurrent MR. Early referral plus improving robotic MVr outcomes will likely continue to reduce AF burden and improve long-term outcomes.
|Total Robotic MVr patients = 603|
Consenting participants analyzed = 574
Patients with pre-operative AF = 55
(n = 519)
|AF + LSM |
(n = 39)
|AF + non-LSM |
(n = 16)
(LSM vs non-LSM)
|SR (%)||AF (%)||SR (%)||AF (%)||SR (%)||AF (%)|
|Post-op||420 (80.9)||99 (19.1)||33 (84.6)||6 (15.4)||11 (68.7)||5 (31.3)||0.27|
|Discharge||513 (99.0)||5 (1.0)||35 (89.7)||4 (10.3)||16 (100.0)||0 (0.0)||0.31|
|>1 year||258 (99.2)||2 (0.8)||22 (95.7)||1 (4.3)||5 (83.3)||1 (16.7)||0.38|
Table 1: Rhythm at follow-up time periods.
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