The Impact Of Cox-maze Operation On Sinus Rhythm Restoration In Patients With Persistent Atrial Fibrillation And Severe Tricuspid Regurgitation
Ilkun Park, Dong Seop Jeong
Samsung Medical Center, Seoul, Korea, Republic of
Objective: Patients with severe tricuspid regurgitation and persistent atrial fibrillation are poor candidates for the Maze operation. This study defines surgical outcomes of Maze operation in these patients. Methods: From 1994 to 2017, all patients with severe tricuspid regurgitation and persistent atrial fibrillation who underwent tricuspid surgery were reviewed retrospectively, and grouped into Maze operation group (Group 1) and non-Maze operation group (Group 2). Clinical and operative characteristics were compared between two groups. Primary outcome was sinus rhythm at last follow-up after the surgery and secondary outcome was survival at last follow-up. Cox multivariate analysis was used to find out prognostic factors of the restoration of sinus rhythm. Median time to follow-up was 50 months. Results: The Cox-Maze operation was done in 181 patients (41.1%). Group 1 had lower EuroSCORE (5.47±2.33 vs. 6.92±2.82, P<0.001), fewer patients with previous cardiac surgery (7.1% vs. 44.3%, P<0.001), more tricuspid repair for severe tricuspid regurgitation (85.6% vs. 64.1%, P<0.001) and longer aortic cross clamp time (128.35±40.55min vs. 108.09±48.58min, P<0.001) than in group 2. At last follow-up, group 1 had more patients with sinus rhythm (66.9% vs. 6.9%, P<0.001) and better survival (73.2% vs. 63.2%, P=0.030) than in group 2. In Cox multivariate analysis, Maze operation (OR=12.689, 95% CI: 7.144-22.537, P<0.001) was an independent prognostic factor for sinus rhythm at last follow-up. Conclusions: In patients with severe tricuspid regurgitation and persistent atrial fibrillation who underwent tricuspid surgery, combined Maze operation showed good conversion rate of sinus rhythm with 66.9% at last follow-up and better survival than in non-Maze group. Patients with severe tricuspid regurgitation are good candidates of Maze operation.
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