Efficacy And Influencing Factors Of Maze Ⅳ Operation On Atrial Fibrillation During Cardiac Valve Surgery

BackgroundAtrial fibrillation is the most common arrhythmia associated with valvular heart disease,which leads to the decrease of cardiac output,hemodynamic changes and the stagnation of left atrial blood,which leads to thrombosis,affects the life quality of patients,and even leads to death.Simple valvular surgery is not the ideal for patients with valvular heart disease and atrial fibrillation.Only a few patients can switch to sinus rhythm after cardiac valve surgery,that will affect the recovery of cardiac function and increase the incidence of related complications.At present,these patients are mostly treated by radiofrequency ablation during concomitant valve surgery.However,some patients still fail to recover or relapse in a short period of time.Further study is needed on the efficacy of radiofrequency ablation during concomitant cardiac valve surgery and the factors influencing the sinus rhythm recovery.ObjectiveTo analyze the efficacy and safety of Maze IV for atrial fibrillation during cardiac valve surgery and the factors that affect the postoperative sinus rhythm recovery.MethodsRetrospective analysis of clinical data of 159 patients who underwent radiofrequency ablation combined with cardiac valve surgery in our hospital from January 2016 to December 2018,including 47 males and 112 females,aged(55.94±9.28)years,weight(60.01±10.75)Kg,duration 6-228 months.Bipolar radiofrequency ablation,ablation line: the connection of superior and inferior vena cava,right atrial incision to tricuspid annulus,inferior vena cava to coronary sinus to tricuspid annulus;left and right pulmonary vein mouth ring line and its connection,left upper pulmonary vein to left atrial appendage connection,left inferior pulmonary vein to mitral annulus connection.The ECG and echocardiogram were reviewed at 3 months,6 months,and 1 year after operation to evaluate the efficacy of surgery and cardioversion of sinus rhythm.According to the results of ECG at 1 year after operation,the patients were divided into two groups: group A(sinus rhythm)and group B(non-sinus rhythm).The general information,indexes of echocardiogram and surgery related data were analyzed for factors that may affect sinus rhythm recovery after surgery.Results157 patients were discharged and 2 patients died(1.3%).The time of aortic cross clamp,cardiopulmonary bypass,operation,mechanical ventilation and length of postoperative hospital stay were(114.20±35.31)min,(173.69±48.79)min,(296.33±67.85)min,(26.60±26.45)h,(16.71±6.07)d.The main postoperative complications were 1 case of secondary thoracotomy and hemostasis(0.6%),10 cases of delayed wound healing(6.3%),9 cases of acute renal failure(5.7%),1 case of severe arrhythmia(0.6%),and 9 cases of pulmonary infection(5.7%).The rates of sinus rhythm reversion at discharge was 58.0%.There were no patients had III degree atrioventricular block,stroke,or permanent cardiac pacemaker implantation after operation and during followed-up.145 patients were followed up,the rate of sinus rhythm conversion was 69.0% at 1 year after operation.The LATD [(52.97±9.17)mm vs(43.35±6.64)mm,t=-7.145,P=0.000] and LVEDD [(49.96±5.34)mm vs(47.92±3.60)mm,t=-2.691,P=0.008] in group A were significantly lower than that in group B,and the LVEF [(56.93±5.65)% vs(59.25±4.99)%,t=2.482,P=0.014] were significantly increased,the difference was statistically significant.There were significant differences between the two groups in age [(54.96±9.15)years vs(58.51±9.05)years,t=-2.169,P=0.032],weight [(58.51±9.55)Kg vs(63.24±13.13)Kg,t=-2.446,P=0.016],duration [(57.33±52.35)months vs(77.73±65.73)months,t=-2.001,P=0.047] cardiac function(z=-2.517,P=0.012),preoperative LATD [(52.19±9.15)mm vs(63.09±14.49)mm,t=-5.484,P=0.000] and the ratio of valvular rheumatic diseases[(55/45)vs(34/11),χ2=5.532,P=0.026].Multivariate analysis showed that age(OR=1.084,95%CI:1.029~1.142,P=0.003),weight(OR=1.064,95%CI:1.023~1.107,P=0.002),the left atrial transverse diameter(OR=1.115,95%CI:1.064~1.167,P=0.000),valvular rheumatic lesions(OR=2.564,95%CI:1.015~6.473,P=0.046)are independent risk factors affecting the surgical effect of patientsConclusions1.Radiofrequency ablation of atrial fibrillation during concomitant cardiac valve surgery is safe and effective,without significantly increasing the mortality and complication rate.2.The recovery and maintenance of sinus rhythm can significantly improve the heart function and myocardial remodeling,reduce the risk of thrombosis and stroke,and improve the quality of life.3.Age,weight,left atrial transverse diameter,and valvular rheumatic lesions before surgery are independent risk factors for sinus rhythm recovery after maze IV operation.