Surgical outcome of the maze procedure for atrial fibrillation in mitral valve disease: rheumatic versus degenerative

The results of the maze procedure are known to be less satisfactory in rheumatic mitral disease than in nonrheumatic mitral valve disease. The aim of this study was to determine whether the etiology of mitral valve disease affected surgical outcome. From July 1997 to January 2001, 129 consecutive patients with chronic atrial fibrillation associated with mitral valve disease had mitral valve operations with the maze procedure. The underlying mitral pathology was rheumatic in 86 patients (group R) and degenerative in 43 (group D). Echocardiograms and electrocardiograms were performed immediately and then repeated 3 months and 6 months postoperatively. The mean age, duration of atrial fibrillation, and preoperative left atrial size were similar between the groups. There was no operative mortality and no significant difference in cardiopulmonary bypass and aortic cross-clamp times. The sinus conversion rate at 7 days postoperatively was 86% in both groups, and at 6 months it was 95.3% in group R and 97.7% in group D (p > 0.05). The transmitral A wave detection rates in groups R and D at 7 days and 6 months postoperatively were, respectively, 63.1% versus 67.4% and 90.4% versus 91.9% (p > 0.05). The transmitral A wave velocity (cm/second) at the same times (7 days and 6 months postoperatively) was 41.9 ± 41.6 versus 45.5 ± 37.7 and 67.8 ± 38.2 versus 69.8 ± 35.8 in groups R and D, respectively (p > 0.05). The maze procedure is equally effective in treating chronic atrial fibrillation in patients with either rheumatic or nonrheumatic mitral valve disease in terms of sinus conversion rate and left atrial transport function.