The Related Study On The Mechanical Mitral Valve Replacement Concomitant Cox-Ⅳ Maze Procedure

Objective:Through the study of patients with atrial fibrillation who underwent the mechanical valve mitral valve implantation,to explore whether Cox-Ⅳ maze procedure can protect this type of patients.Methods:Patients with atrial fibrillation who underwent the mechanical valve mitral valve implantation in our hospital from February 2016 to February 2019 were selected.According to the proposed inclusion and exclusion criteria,87 patients were eventually selected and considered as the study objects.Patients were divided into the maze group and non-maze group according to whether Cox-Ⅳ maze procedure was performed during the same period.Among them,there were 40 people in the maze group and 47 people in the non-maze group.Through the electronic medical record system in our hospital,the general information,perioperative related data,and postoperative follow-up data of patients were collected.For patients who had not been followed up in our hospital,relevant data were obtained by telephone.Follow-up observation indicators included the sinus rhythm maintenance rate,cardiac function-related indicators,thromboembolism and bleeding events,and improvement situations of symptoms.Through the IBM SPSS 23.0 Statistics statistical analysis software,the relevant data was statistically analyzed.The differences of the two groups of patients were compared in terms of the preoperative general information,surgical complications,postoperative sinus rhythm,cardiac function-related indicators,embolism and bleeding events,improvement situations of symptoms and other aspects.Ultimately,it provided the clinical evidence for whether patients atrial fibrillation who underwent the mechanical valve mitral valve implantation can benefit from maze procedure.Results:Compared with the non-maze group,the cardiopulmonary bypass time,aortic occlusion time,postoperative drainage volume,and postoperative creatinine value inthe maze group were higher(135.15±37.97 min vs 112.51±50.15 min,98.70±42.36 min vs 82.20±39.51 min,619.00±431.54 vs 447.87±171.55 ml,97.23±35.39 vs 84.83±13.51μmol/L),the results were different(p <0.05).There were no significant differences in the amount of intraoperative blood loss,perioperative blood transfusion,mechanical ventilation time,ICU time,postoperative hospitalization days,perioperative complications and other aspects.(P> 0.05).Compared with the non-maze group,postoperative sinus rhythm maintenance rate in the maze group increased significantly.Patients in the maze group were followed up for 19.83 ± 10.52 months after operation,and results found that 92.5% of patients could maintain sinus rhythm.The maze group had certain advantages in reducing the diameter of the left atrium(45.58 ± 7.87 vs 50.11 ± 9.96mm),decreasing the autonomic heart rate(73.25 ±5.415 vs 96.36 ± 10.303),left ventricular ejection fraction and improving postoperative symptoms aspects(p <0.05).During the follow-up period,there were no significant differences between the two groups in terms of the thromboembolism(2.5% vs 6.38%),bleeding rate,,left ventricular end-systolic diameter,and left ventricular end-diastolic diameter aspects(P> 0.05).Conclusion:Cox-Ⅳ maze surgery is an important method for the treatment of atrial fibrillation.Simultaneous maze surgery is safe and effective.It can significantly improve the hemodynamic indicators and improve the quality of life after surgery.Survival benefits still require further follow-up.