Abstract 14860: Time-dependent Development of Symptomatic Bradyarrhythmia After Maze Procedure Concomitantly Done During Mitral Valve Surgery: Impact of Underlying Etiology and Lesion Extent
Background: Significant proportions of patients who need mitral valve surgery (MVS) are a potential candidate for maze procedure. However, impact of different etiology (rheumatic vs. non-rheumatic) and lesion extent (biatrial vs. left atrial maze) needs to be clarified.
Methods: Clinical data of 750 consecutive patients (age 57 ± 12 years) who underwent MVS and maze were analyzed. Symptomatic bradyarrhythmia (SB) include sick sinus syndrome (SSS) and high-degree atrioventricular block (AVB) during follow-up (4.1 ± 2.9 years).
Results: MV replacement was done in 446 patients (60%) and rheumatic etiology was confirmed in 431 (57%). The incidence of SB at the 1, 3, and 5 years after surgery was 3.9%, 5.3%, and 6.8%, respectively. Development of AVB mostly confined to the immediate postoperative period, whereas SSS showed time-dependent increase with higher incidence compared to AVB. Patients who developed SB showed significantly lower 4-year clinical event (death, stroke and hospital admission) - free survival rates (37.1 ± 8.1% vs. 67.0 ± 2.0%, p<0.001). After adjustment of age, cardiopulmonary bypass time and preoperative peak systolic pulmonary artery pressure, biatrial maze procedure was an independent predictor of SB development (hazard ratio [HR] 3.07, 95% CI 1.08-8.76, p=0.036). Rheumatic etiology was not an additive risk factor of SB development (HR 1.13, 95% CI 0.61-2.10, p=0.692). Adverse effect of biatrial maze was confirmed in patients with trivial or mild preoperative tricuspid regurgitation (TR) showing higher incidence of SB during 4 years of follow-up (6.6 ± 1.7% vs.1.0 ± 0.7%, p=0.009), whereas lesion extent did not affect SB development in those with moderate to severe TR (8.5 ± 1.8% vs. 3.8 ± 3.8%, p=0.229).
Conclusion: Ongoing risk of SB development should be regarded as a potential complication of maze procedure and tailored selection of lesion extent according to TR severity is warranted.
Author Disclosures: M. Cho: None. R. Heo: None. X. Jin: None. S. Lee: None. D. Kim: None. J. Kim: None. J. Song: None. G. Nam: None. K. Choi: None. D. Kang: None. J. Lee: None. J. Song: None.
- © 2016 by American Heart Association, Inc.