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Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation
  1. Joon Bum Kim1,
  2. Min Ho Ju1,
  3. Sung Cheol Yun2,
  4. Sung Ho Jung1,
  5. Cheol Hyun Chung1,
  6. Suk Jung Choo1,
  7. Taek Yeon Lee1,
  8. Hyun Song3,
  9. Jae Won Lee1
  1. 1Department of Thoracic and Cardiovascular Surgery University of Ulsan, College of Medicine, Seoul, South Korea
  2. 2Preventive Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
  3. 3Department of Thoracic and Cardiovascular Surgery, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
  1. Correspondence to Dr Jae Won Lee, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong Songpa-gu, Seoul 138-736, South Korea; jwlee{at}


Background Although the Maze procedure is regarded as the most effective way to restore sinus rhythm in patients with chronic atrial fibrillation (AF), it remains unclear whether this procedure offers long-term clinical benefits in patients undergoing mechanical valve replacement.

Methods and results Between 1999 and 2007, 402 patients with AF-associated mitral valve (MV) disease underwent MV replacement with a mechanical prosthesis. Of these patients, 159 underwent valve replacement plus the Maze procedure, whereas 243 received valve replacement alone. The composite end points of cardiac death and cardiac-related morbidities were compared in these two groups using the inverse-probability-of-treatment-weighted method. At a median follow-up time of 63.1 months (range 0.2–123.9 months), patients who had undergone the Maze procedure were at significantly lower risk of thromboembolic events (hazard ratio (HR)=0.26, 95% confidence interval (CI) 0.07 to 0.95; p=0.041) and were at comparable risk of death (HR=0.96, 95% CI 0.44 to 2.07; p=0.907) and cardiac death (HR=1.26, 95% CI 0.53 to 3.01; p=0.598) compared with patients who underwent MV replacement alone. The composite risk of death or major events was lower in the Maze procedure group (HR=0.64, 95% CI 0.38 to 1.08; p=0.093).

Conclusions Compared with MV replacement alone, the addition of the Maze procedure was associated with a reduction in thromboembolic complications and better long-term event-free survival in patients with AF undergoing mechanical MV replacement. Prospective randomised data are necessary to confirm the findings of this study.

  • Atrial arrhythmias
  • surgery-valve
  • prosthetic heart valves

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee/review board of Asan Medical Center, Seoul, Korea.

  • Provenance and peer review Not commissioned; externally peer reviewed.