Impact of maze procedure in patients with severe tricuspid regurgitation and persistent atrial fibrillation

ABSTRACT Objective Patients with severe tricuspid regurgitation (TR) and persistent atrial fibrillation (AF) may not be good candidates for maze procedure due to preoperative atrial remodeling and various comorbidities. We attempted to evaluate the rhythm and clinical outcomes of maze procedure in these patients. Methods Patients with severe TR and persistent AF who underwent tricuspid valve (TV) surgery between January 1994 and December 2017 at a single tertiary center were analyzed. The primary endpoint was sinus rhythm restoration. The key secondary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), which is the composite event of stroke, cardiac death, major bleeding, and readmission for heart failure. Propensity score matching analysis was used. Results A total of 388 patients underwent TV surgery, and among them 172 patients (44%) underwent concomitant maze procedure. The maze group had sinus rhythm restoration rate of 56% in 9 years. Further, in the matched cohort, the maze group had higher freedom from MACCE rate at 10 years than the non-maze group (55.6% vs. 36.2%, P = .047). Preoperative left atrial diameter (hazard ratio [HR], 1.022; 95% confidence interval [CI], 1.012–1.033; P Conclusions Maze procedure in severe TR and persistent AF had acceptable rate of sinus rhythm restoration and reduced MACCE in the long-term. Careful patient selection considering preoperative atrial diameters is needed to enhance maze success rate and long-term clinical outcomes.