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A Modified Maze Versus Cut-and-Sew Maze for Long-Standing Persistent Atrial Fibrillation Concomitant with Mitral

Huishan Wang1, Jinsong Han1, Zengwei Wang1

  • 1Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.

Heart, Lung & Circulation
|August 20, 2022
PubMed

Insights

A modified maze procedure for atrial fibrillation (AF) reduces operating time compared to the standard cut-and-sew maze (CSM) while maintaining similar efficacy in preventing AF recurrence after mitral valve surgery.

Area of Science:

  • Cardiac Surgery
  • Electrophysiology
  • Minimally Invasive Procedures

Background:

  • The standard cut-and-sew maze (CSM) procedure effectively treats persistent atrial fibrillation (AF) during mitral valve surgery.
  • CSM's complexity and prolonged cardiopulmonary bypass times limit its widespread adoption.

Purpose of the Study:

  • To evaluate a modified maze procedure combining left atrial "cut-and-sew" with right atrial cryoablation and cavotricuspid isthmus ablation.
  • To compare the early operative outcomes and long-term efficacy of the modified maze with the standard CSM procedure.

Main Methods:

  • A retrospective analysis of 229 patients undergoing CSM and 43 undergoing the modified maze procedure during mitral valve surgery.
  • Propensity score matching (1:2 ratio) was used to compare outcomes between 43 modified maze patients and 86 CSM patients.
  • Atrial fibrillation recurrence rates at 2 years, absence of anti-arrhythmic drug use, and operative times were analyzed.

Main Results:

  • The modified maze procedure demonstrated significantly shorter aortic cross-clamp times (76.3 vs. 92.4 minutes, p<0.001).
  • No significant difference in early mortality (0% vs. 1.1%, p=0.722) or late strokes/deaths was observed between groups.
  • Both procedures showed similar rates of freedom from AF recurrence without anti-arrhythmic drugs at 2 years (p=0.332).

Conclusions:

  • The modified maze procedure simplifies the "cut-and-sew" technique and reduces operative time.
  • This approach maintains the high efficacy of CSM for eliminating persistent AF in patients undergoing mitral valve surgery.
Abstract

Keywords:
CryoablationCut-and-sew mazeLong-standing persistent atrial fibrillationMitral valve surgerySurgical ablation

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