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Long-Term Outcomes of the Maze Procedure Combined with Endoatriectomy for Patients with Calcified Left Atria

Yochun Jung1, Kyo Seon Lee1, Sang Gi Oh1

  • 1Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|April 16, 2023
PubMed

Insights

Left atrial calcification (LAC) impacts maze procedure outcomes. Limited LAC shows better long-term rhythm control after endoatriectomy and maze surgery, suggesting feasibility in select patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Left atrial calcification (LAC) is common in rheumatic valvular disease and strongly associated with atrial fibrillation (AF).
  • Endoatriectomy is necessary during the maze procedure for patients with LAC, but its feasibility and outcomes are not well-established.

Purpose of the Study:

  • To evaluate the technical feasibility and long-term outcomes of the maze procedure combined with endoatriectomy in patients with left atrial calcification.
  • To assess the impact of LAC extent on rhythm control and recurrence of AF post-surgery.

Main Methods:

  • Retrospective analysis of 18 patients undergoing combined endoatriectomy and maze procedure.
  • Patients were categorized into "broad" (LAC > 50% of left atrium) and "limited" (LAC ≤ 50%) groups.
  • Follow-up included rhythm assessment via electrocardiography and AF recurrence rates.

Main Results:

  • One operative death occurred due to sepsis.
  • No significant difference in postoperative complications between broad and limited LAC groups.
  • At 11.4 years median follow-up, AF recurred in 11 patients.
  • Significantly fewer patients in the broad LAC group maintained sinus rhythm (P=0.03).
  • 10-year AF recurrence-free survival was 13.9% for broad LAC vs. 66.7% for limited LAC (P=0.01).

Conclusions:

  • The maze procedure with endoatriectomy is technically feasible in patients with LAC.
  • Limited LAC extent is associated with acceptable long-term rhythm outcomes.
  • Extensive LAC may predict poorer long-term rhythm control after the maze procedure.
Abstract

Keywords:
atrial fibrillationendoatriectomyleft atrial calcificationmaze procedure

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