Short-term outcome of mitral valve replacement and atrial fibrillation ablation procedure for patients with mitral valve stenosis and atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Hao , YANG Yiren , MA Ning , ZHANG Xin ,  QIAO Chenhui

Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P.R.China;

Corresponding author：

QIAO Chenhui, Email: qchenhui@hotmail.com

Keywords：

Ablation; mitral valve stenosis; atrial fibrillation

DOI：

10.7507/1007-4848.201711034

Video：

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Objective To evaluate the short-term outcome and influence of atrial fibrillation ablation and mitral valve replacement for patients with mitral valve stenosis and atrial fibrillation. Methods Retrospective analysis was conducted for 44 patients with rheumatic mitral valve stenosis and atrial fibrillation who experienced mitral valve replacement with or without surgical atrial fibrillation ablation procedure in our hospital from January 2016 to June 2017. Eighteen patients experienced mitral valve replacement and surgical atrial fibrillation ablation procedure (a group 1), and the other 26 patients experienced mitral valve replacement without surgical atrial fibrillation ablation procedure (a group 2). In th group 1, there were 4 males and 14 females, aged 43-67 (55.67±7.56) years, and in the group 2 there were 6 males and 20 females, aged 40-72 (54.81±8.81) years. The patients’ data, preoperative echocardiography, surgery procedures, perioperative events, echocardiography and electrocardiogram at postoperative three months were collected to evaluate the short-term outcome and influence of surgical atrial fibrillation ablation procedure for those patients. Results There was no statistical difference in the operation duration (P=0.867) and ICU stay (P=0.550) between the two groups. But the group 1 had longer extracorporeal circulation duration (P=0.006) and aorta arrest duration (P=0.001) than the group 2. No patient died perioperatively and one patient from the group 1 experienced reoperation because of too much chest tube drainage. At three months after operation, echocardiography and electrocardiogram examination showed that 16 patients in the group 1 and 2 patients in the group 2 had sinus rhythm. There was no statistical difference between postoperative and preoperative examination about variation in left ventricle ejection fraction, pulmonary arterial systolic pressure, left atrial diameter and left ventricular end diastolic diameter between the two groups (all P>0.05). Conclusion Atrial fibrillation ablation does not increase the risk of mitral valve replacement for patients who have mitral valve stenosis and atrial fibrillation. The rate of converting to sinus rhythm is high, but additional atrial fibrillation ablation procedure does not have positive or negative influence on short-term recovery of cardiac structure and function after operation.

Citation： XU Hao, YANG Yiren, MA Ning, ZHANG Xin, QIAO Chenhui. Short-term outcome of mitral valve replacement and atrial fibrillation ablation procedure for patients with mitral valve stenosis and atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 786-790. doi: 10.7507/1007-4848.201711034 Copy

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2.	Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
3.	Rodman T, Pastor BH, Figueroa W. Effect on cardiac output of conversion from atrial fibrillation to normal sinus mechanism. Am J Med, 1966, 41(2): 249-258.
4.	O'Neal WT, Salahuddin T, Broughton ST, et al. Atrial fibrillation and cardiovascular outcomes in the elderly. Pacing Clin Electrophysiol, 2016, 39(9): 907-913.
5.	Albåge A, Johansson B, Kennebäck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2016, 101(4): 1443-1449.
6.	Weimar T, Bailey MS, Watanabe Y, et al. The Cox-maze Ⅳ procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients. J Interv Card Electrophysiol, 2011, 31(1): 47-54.
7.	Lawrance CP, Henn MC, Miller JR, et al. Comparison of the stand-alone Cox-Maze Ⅳ procedure to the concomitant Cox-Maze Ⅳ and mitral valve procedure for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 55-61.
8.	梅举, 姜兆磊, 汤敏, 等. 微创心脏瓣膜手术同期双房冷冻消融治疗合并心房颤动. 中国胸心血管外科临床杂志, 2017, 22(1): 25-29.
9.	Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol, 1998, 82(8A): 10N-17N.
10.	Mandal RN, Mishra AK, Mandal EL. Clinical and etiological profile of patients with atrial fibrillation (AF): Analysis and implications. J Med Sci, 2016, 4(1): 5.
11.	龚启华, 张大国, 向道康, 等. 同期房颤双极射频消融对二尖瓣机械瓣膜置换术疗效的影响. 广东医学, 2013, 34(23): 3611-3613.
12.	张锡武, 王树伟, 张本, 等. 房颤对主动脉瓣置换术患者早期预后的影响. 第二军医大学学报, 2014, 35(3): 265-269.
13.	Albåge A, Sartipy U, Kennebäck G, et al. Long-term risk of ischemic stroke after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2017, 104(2): 523-529.
14.	Fukuda Y, Yoshida T, Inage T, et al. Long-term results of the maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels, 2012, 27(1): 53-57.
15.	Bum Kim J, Suk Moon J, Yun SC, et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure. Circulation, 2012, 125(17): 2071-2080.
16.	Araki Y, Oshima H, Usui A, et al. Long-term results of the Maze procedure in patients with mechanical valve. Gen Thorac Cardiovasc Surg, 2012, 60(6): 326-333.

1. 马长生. 房颤的流行病学进展. 医学与哲学, 2016, 37(22): 7-9.
2. Lip GY. Stroke prevention in atrial fibrillation. Eur Heart J, 2017, 38(1): 4-5.
3. Rodman T, Pastor BH, Figueroa W. Effect on cardiac output of conversion from atrial fibrillation to normal sinus mechanism. Am J Med, 1966, 41(2): 249-258.
4. O'Neal WT, Salahuddin T, Broughton ST, et al. Atrial fibrillation and cardiovascular outcomes in the elderly. Pacing Clin Electrophysiol, 2016, 39(9): 907-913.
5. Albåge A, Johansson B, Kennebäck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2016, 101(4): 1443-1449.
6. Weimar T, Bailey MS, Watanabe Y, et al. The Cox-maze Ⅳ procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients. J Interv Card Electrophysiol, 2011, 31(1): 47-54.
7. Lawrance CP, Henn MC, Miller JR, et al. Comparison of the stand-alone Cox-Maze Ⅳ procedure to the concomitant Cox-Maze Ⅳ and mitral valve procedure for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 55-61.
8. 梅举, 姜兆磊, 汤敏, 等. 微创心脏瓣膜手术同期双房冷冻消融治疗合并心房颤动. 中国胸心血管外科临床杂志, 2017, 22(1): 25-29.
9. Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol, 1998, 82(8A): 10N-17N.
10. Mandal RN, Mishra AK, Mandal EL. Clinical and etiological profile of patients with atrial fibrillation (AF): Analysis and implications. J Med Sci, 2016, 4(1): 5.
11. 龚启华, 张大国, 向道康, 等. 同期房颤双极射频消融对二尖瓣机械瓣膜置换术疗效的影响. 广东医学, 2013, 34(23): 3611-3613.
12. 张锡武, 王树伟, 张本, 等. 房颤对主动脉瓣置换术患者早期预后的影响. 第二军医大学学报, 2014, 35(3): 265-269.
13. Albåge A, Sartipy U, Kennebäck G, et al. Long-term risk of ischemic stroke after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2017, 104(2): 523-529.
14. Fukuda Y, Yoshida T, Inage T, et al. Long-term results of the maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels, 2012, 27(1): 53-57.
15. Bum Kim J, Suk Moon J, Yun SC, et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure. Circulation, 2012, 125(17): 2071-2080.
16. Araki Y, Oshima H, Usui A, et al. Long-term results of the Maze procedure in patients with mechanical valve. Gen Thorac Cardiovasc Surg, 2012, 60(6): 326-333.

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Short-term outcome of mitral valve replacement and atrial fibrillation ablation procedure for patients with mitral valve stenosis and atrial fibrillation

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