Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Sick sinus syndrome (SSS) is a potential complication following cardiac surgery.
• The additive maze procedure (MP) is used during mitral valve surgery, but its impact on SSS development requires further characterization.

Purpose of the Study:

• To investigate the incidence and risk factors for sick sinus syndrome (SSS) after the additive maze procedure (MP) in patients undergoing mitral valve surgery.
• To evaluate the association between SSS development and clinical outcomes, as well as the influence of lesion extent and underlying etiology.

Main Methods:

• A retrospective analysis of follow-up data from 750 patients who underwent mitral valve surgery with additive maze procedure.
• Time-dependent incidence rates of SSS and pacemaker implantation were calculated.
• Hazard ratios were determined to assess the risk of SSS and clinical events associated with MP and lesion extent.

Main Results:

• Sick sinus syndrome (SSS) developed in 35 patients, with incidence increasing over time (4.3% at 4 years).
• The additive maze procedure (MP) significantly increased the risk of SSS (HR 7.44) and pacemaker implantation (HR 3.61).
• Biatrial MP extent, not rheumatic cause, was independently associated with SSS development (HR 3.58), particularly in patients with mild tricuspid regurgitation.

Conclusions:

• Patients undergoing additive maze procedure (MP) face an ongoing risk of sick sinus syndrome (SSS) development, irrespective of the underlying cause.
• Biatrial MP extent is a significant risk factor for SSS and associated adverse clinical events.
• Minimizing the lesion extent of the MP, particularly avoiding extensive biatrial lesions, is crucial for reducing SSS incidence and improving patient outcomes.