النتائج الفورية لإجراء النمط الثالث من عملية المتاهة Maze-III بالمشاركة مع الجراحة التاجية عند المرضى المصابين بالآفات الرثوية مع الرجفان الأذيني المزمن

Abstract EN

Objective: Elimination of atrial fibrillation is an important target of therapy in rheumatic mitral valve disease, and the Maze procedure represents the most effective approach to recover sinus rhythm.

We reviewed the results of performing the Maze-III procedure in combination with mitral surgery in a group of patients with rheumatic disease and chronic atrial fibrillation.

Methods: A group of 32 patients (mean age 46.4±11.2 years) underwent standard mitral valve surgery in combination with the Maze-III (cut-and-sew) procedure.

Postoperatively, heart rhythm was monitored continuously, temporary pacing was employed as required, and amiodarone was used to control tachyarrhythmias.

Electric cardioversion was attempted prior to discharge whenever atrial fibrillation persisted.

Results: At the end of the procedure, immediate conversion to sinus rhythm occurred in 17 patients, and to nodal rhythm in 14 patients, while atrial fibrillation persisted in one patient only.

Temporary pacing was used in 6 patients postoperatively, but none required permanent pace-maker implantation.

Sinus rhythm persisted in all patients who converted immediately at the end of the procedure, and was recovered in 8 more patients who had converted to nodal rhythm.

Upon discharge, 78.1% of all patients were in sinus rhythm and 12.5% were in nodal rhythm, while atrial fibrillation persisted in 9.4% of patients.

Pulmonary artery pressures and left atrial diameter were not found on multivariate statistical analysis to influence operative results significantly.

Conclusions: This approach is rewarded by the return of sinus rhythm in a high percentage of patients with rheumatic disease and chronic atrial fibrillation, and is not associated with an increase in the rate of postoperative complications.