Concomitant MAZE procedure during cardiac surgical procedures

Is there any survival advantage in conversion to sinus rhythm?

S. Neragi-Miandoab, E. Skripochnik, R. E. Michler, Paul Andrew Friedman, D. A. D'Alessandro

Research output: Contribution to journalArticle

Abstract

Aim. The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently. Methods. We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2% were female (N.=109). Perioperative mortality was 5.74% (N.=12). Results. In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality. Conclusion. The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.

Original languageEnglish (US)
Pages (from-to)389-396
Number of pages8
JournalMinerva Cardioangiologica
Volume63
Issue number5
StatePublished - Oct 1 2015
Externally publishedYes

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Cardiac Surgical Procedures
Survival
Mortality
Survival Rate
Creatinine
Multivariate Analysis
Perfusion
Chronic Obstructive Pulmonary Disease
Renal Insufficiency
Asthma

Keywords

  • Arrhythmias, cardiac
  • Atrial fibrillation
  • Heart rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Concomitant MAZE procedure during cardiac surgical procedures : Is there any survival advantage in conversion to sinus rhythm? / Neragi-Miandoab, S.; Skripochnik, E.; Michler, R. E.; Friedman, Paul Andrew; D'Alessandro, D. A.

In: Minerva Cardioangiologica, Vol. 63, No. 5, 01.10.2015, p. 389-396.

Research output: Contribution to journalArticle

Neragi-Miandoab, S. ; Skripochnik, E. ; Michler, R. E. ; Friedman, Paul Andrew ; D'Alessandro, D. A. / Concomitant MAZE procedure during cardiac surgical procedures : Is there any survival advantage in conversion to sinus rhythm?. In: Minerva Cardioangiologica. 2015 ; Vol. 63, No. 5. pp. 389-396.
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title = "Concomitant MAZE procedure during cardiac surgical procedures: Is there any survival advantage in conversion to sinus rhythm?",
abstract = "Aim. The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently. Methods. We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2{\%} were female (N.=109). Perioperative mortality was 5.74{\%} (N.=12). Results. In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88{\%}±2.2{\%}, and 76{\%}±3.3{\%}, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88{\%}±2.6{\%} and 80{\%}±3.5{\%}, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94{\%}±3{\%} and 82{\%}±6.6{\%}, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality. Conclusion. The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.",
keywords = "Arrhythmias, cardiac, Atrial fibrillation, Heart rate",
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T1 - Concomitant MAZE procedure during cardiac surgical procedures

T2 - Is there any survival advantage in conversion to sinus rhythm?

AU - Neragi-Miandoab, S.

AU - Skripochnik, E.

AU - Michler, R. E.

AU - Friedman, Paul Andrew

AU - D'Alessandro, D. A.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Aim. The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently. Methods. We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2% were female (N.=109). Perioperative mortality was 5.74% (N.=12). Results. In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality. Conclusion. The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.

AB - Aim. The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently. Methods. We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2% were female (N.=109). Perioperative mortality was 5.74% (N.=12). Results. In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality. Conclusion. The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.

KW - Arrhythmias, cardiac

KW - Atrial fibrillation

KW - Heart rate

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