CAN THE MAZE PROCEDURE BE COMBINED SAFELY WITH MITRAL-VALVE REPAIR

Background and aims of the study: The safety of combining mitral valve repair with the maze procedure for chronic atrial fibrillation in the surgical management of patients with mitral valve disease is not well elucidated. We present our operative results regarding mortality and morbidity after such combined surgery. As a comparison, our operative results after mitral valve repair in patients without chronic atrial f ibrillation are presented. Methods: Between April 1993 and December 19 94, 39 patients with chronic atrial fibrillation underwent mitral valv e repair and concomitant maze procedure (group 1) at the Iwate Medical University. During the same period, 36 patients with sinus rhythm and one patient with DDD pacemaker underwent mitral valve repair (group 2 ). In order to evaluate the operative risk, morbidity, and mortality o f adding the maze procedure to mitral valve repair, total cardiopulmon ary bypass time, aortic cross-clamp time, intraoperative blood loss, i ntubation period, and duration of ICU stay were compared between the g roups. Results: Total cardiopulmonary bypass time and aortic cross-cla mp time in group 1 were longer than in group 2 (174.0 +/- 38.8 min ver sus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus 95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU stay, intubation p eriod, and intraoperative blood loss were not different between the gr oups. There were no hospital deaths in either group. Four patients in group 1, and two patients in group 2 required re-exploration for bleed ing (p = NS). Two patients in group 1, and none in group 2 required pa cemaker implantation postoperatively (p = NS). Two patients in group 2 , and none in group 2 had minor cerebral infarction (p = NS). At hospi tal discharge, 28 patients in group 1 (72%) and 35 patients (97%) in g roup 2 were in sinus rhythm. Conclusions: The maze procedure can be co mbined with mitral valve repair without adding undue operative risk to patients. Those patients with chronic atrial fibrillation undergoing mitral valve repair may be advised for the possibility of concomitant maze procedure.