Long-Term Outcomes of Mechanical Valve Replacement in Patients with Atrial Fibrillation: Impact of the Maze Procedure
Background—The long-term benefits of the Maze procedure in patients with chronic atrial fibrillation (AF) undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear.
Methods and Results—We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure or valve-related complications) in 569 patients with AF-associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant Maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the Maze procedure were at similar risks of death (hazard ratio 1.15, 95% CI 0.65-2.03, P=0.63) and the composite outcomes (hazard ratio 0.82, 95% CI 0.50-1.34, P=0.42), but were at a significantly lower risk of thromboembolic events (hazard ratio 0.29, 95% CI 0.12-0.73, P=0.008) than those who underwent valve replacement alone at a median follow-up of 63.6 months (range 0.2-149.9 months). The effect of superior event-free survival by the concomitant Maze procedure was notable in a low risk EuroSCORE (0-3) subgroup (P=0.049), but it was insignificant in a high risk EuroSCORE (≥4) subgroup (P=0.65). Furthermore, the combination of the Maze procedure resulted in superior left ventricular (P<0.001) and tricuspid valvular functions (P<0.001) compared to valve replacement alone on echocardiographic assessments performed at median 52.7 months (range, 6.0-146.8 months) after surgery.
Conclusions—Compared with valve replacement alone, the addition of the Maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.