Maze procedure in patients with left ventricular dysfunction.

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• The clinical impact of concomitant Maze procedures in patients with left ventricular (LV) dysfunction and atrial fibrillation (AF) undergoing major cardiac surgery remains unclear.
• This study investigates the benefits and risks associated with the Maze procedure in this specific patient population.

Purpose of the Study:

• To evaluate the clinical outcomes of performing a concomitant Maze procedure alongside major cardiac surgery in patients with valvular atrial fibrillation and LV dysfunction.
• To compare adverse events, functional status, and anticoagulation requirements between patients who underwent the Maze procedure and those who did not.

Main Methods:

• A cohort of 139 patients with valvular AF and LV ejection fraction ≤40% were analyzed, comparing those who had (n=77) versus those who did not have (n=62) a concomitant Maze procedure during open heart surgery.
• Adverse outcomes, including mortality, thromboembolic events, and congestive heart failure hospitalizations, were assessed over a median follow-up of 66 months.
• Propensity score and inverse probability weighting were used for statistical adjustment of baseline characteristics.

Main Results:

• The Maze procedure group showed significantly lower risks of death (HR 0.39, P=0.033) and composite adverse outcomes (HR 0.28, P=0.017) after adjustment.
• Patients undergoing the Maze procedure demonstrated superior functional status (P<0.001).
• The need for long-term anticoagulation therapy was significantly reduced in the Maze procedure group (67.1% vs. 91.2%, P=0.001).

Conclusions:

• Concomitant Maze procedure in patients with valvular AF and LV dysfunction effectively reduces serious adverse outcomes compared to cardiac surgery alone.
• The Maze procedure improves functional status and decreases the long-term need for anticoagulation therapy in this patient cohort.