Document Detail


Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation.
MedLine Citation:
PMID:  20363476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The long-term outcomes of combined mitral repair and maze procedure for patients with nonrheumatic mitral regurgitation and chronic atrial fibrillation were evaluated.
METHODS: Between June 1992 and December 2008, 187 patients underwent a combined mitral repair and maze procedure. The mean follow-up period was 7.4 ± 4.3 years. Chordal reconstruction was performed in 69 patients, leaflet resection in 91, edge-to-edge leaflet suture in 30, and ring annuloplasty in 156. In addition, a cryo-maze procedure was applied in 110, and a Cox-Kosakai maze and radiofrequency maze were applied in the others.
RESULTS: There were 2 operative deaths and the 15-year survival was 71%. The 15-year freedom from greater than grade 3 mitral regurgitation was 61%; rates of freedom from heart failure (New York Heart Association class ≥ III) and reoperations were 79% and 91%, respectively. Cardiac function was improved and left ventricular size was decreased significantly postoperatively. Multivariate analysis showed that a large left ventricular diastolic diameter (≥65 mm) was an independent risk factor for recurrent mitral regurgitation. Eleven thromboembolic episodes (0.79%/patient-year) were detected during follow-up examinations, of which 7 occurred in patients with recurrent atrial fibrillation. Sinus rhythm was regained in 86% after 6 months and in 63% after 15 years. Multivariate analysis showed that a small-voltage f wave was an independent risk factor for AF recurrence.
CONCLUSIONS: A combined mitral valve repair and maze procedure provided low rates of morbidity and mortality and led to well-preserved cardiac function. Left ventricular diastolic diameter and f-wave voltage can be accurate predictors of good long-term outcome.
Authors:
Tomoyuki Fujita; Junjiro Kobayashi; Koichi Toda; Hiroyuki Nakajima; Yutaka Iba; Yusuke Shimahara; Toshikatu Yagihara
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Publication Detail:
Type:  Journal Article     Date:  2010-04-03
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-16     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1332-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan. tfujita@hsp.ncvc.go.jp
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / complications,  mortality,  surgery*,  ultrasonography
Cardiac Surgical Procedures / methods*,  mortality
Catheter Ablation / methods,  mortality
Chronic Disease
Echocardiography
Female
Humans
Male
Middle Aged
Mitral Valve Insufficiency / complications,  mortality,  surgery*,  ultrasonography
Proportional Hazards Models
Reconstructive Surgical Procedures / methods,  mortality
Reoperation
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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