Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xinting ^1,2 , WANG Huishan ² ,  HAN Jinsong ² , YIN Zongtao ² , ZHANG Yingjie ² , LUO Yu ² , LIANG Hanqing ² , GUO Zhipeng ²

1. Graduate School, Jinzhou Medical University, Shenyang, 110016, P. R. China;
2. Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Cryoablation; Maze procedure; elderly patients; mitral valve disease; atrial fibrillation; propensity-score matching study

DOI：

10.7507/1007-4848.202011004

Video：

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Objective To evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.Methods From May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups.Results After PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05).Conclusion The mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.

Citation： CHEN Xinting, WANG Huishan, HAN Jinsong, YIN Zongtao, ZHANG Yingjie, LUO Yu, LIANG Hanqing, GUO Zhipeng. Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 748-754. doi: 10.7507/1007-4848.202011004 Copy

1.	Lip GYH, Collet JP, Caterina R, et al. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: A joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace, 2017, 19(11): 1757-1758.
2.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议(2018). 中国心律失常学杂志, 2018, 22(4): 279-344.
3.	Morin DP, Bernard ML, Madias C, et al. The state of the art: Atrial fibrillation epidemiology, prevention, and treatment. Mayo Clin Proc, 2016, 91(12): 1778-1810.
4.	Banerjee A, Allan V, Denaxas S, et al. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: Phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5.	Esteves AF, Brito D, Rigueira J, et al. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
6.	Ad N, Holmes SD, Massimiano PS, et al. Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2018, 155(3): 983-994.
7.	Wang H, Han J, Wang Z, et al. Efficacy of cut-and-sew surgical ablation for atrial fibrillation in patients with giant left atria undergoing mitral valve surgery: A propensity-matched analysis. Semin Thorac Cardiovasc Surg, 2019, 31(4): 796-802.
8.	韩劲松, 王辉山, 汪曾炜, 等. Cox迷宫Ⅲ型手术治疗风湿性二尖瓣病变伴发心房颤动的安全性和有效性. 中华医学杂志, 2016, 96(13): 1011-1015.
9.	韩劲松, 王辉山, 汪曾炜, 等. 倾向性评分法评价迷宫Ⅲ手术治疗退行性二尖瓣病变合并房颤的安全性和疗效. 中华胸心血管外科杂志, 2017, 33(8): 466-471.
10.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
11.	Curiel-Balsera E, Mora-Ordoñez JM, Castillo-Lorente E, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care, 2013, 28(4): 397-404.
12.	Badhwar V, Rankin JS, Damiano RJ Jr, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
13.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
14.	Mizrahi EH, Fleissig Y, Arad M, et al. Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients. Arch Gerontol Geriatr, 2014, 58(1): 121-124.
15.	马超, 王辉山, 韩劲松, 等. 瓣膜性心房颤动冷冻消融迷宫Ⅳ术后心房收缩功能恢复规律分析. 中国胸心血管外科临床杂志, 2020, 27(9): 1045-1054.
16.	韩劲松, 王辉山, 尹宗涛, 等. 两种人工瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全的比较. 中国组织工程研究, 2015, 19(16): 2578-2582.
17.	Lombard FW, Liang Y. Risk factors for mitral valve surgery: Atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
18.	Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
19.	Ad N, Damiano RJ, Badhwar V, et al. Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(6): 1330-1354.
20.	Gomes GG, Gali WL, Sarabanda AVL, et al. Late results of Cox Maze Ⅲ procedure in patients with atrial fibrillation associated with structural heart disease. Arq Bras Cardiol, 2017, 109(1): 14-22.
21.	Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze Ⅳ procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(1): 159-170.
22.	Labin JE, Haque N, Sinn LA, et al. The Cox-Maze Ⅳ procedure for atrial fibrillation is equally efficacious in patients with rheumatic and degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2017, 154(3): 835-844.
23.	Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
24.	韩博, 于建波, 朱恩军, 等. 高龄患者心脏瓣膜手术联合冠状动脉旁路移植术发生院内死亡的危险因素分析. 实用医院临床杂志, 2017, 14(2): 36-39.
25.	Hothi S, Tan D, MacDonald W, et al. Does intervention of severe valve lesions always improve cardiac function. Heart, 2015, 101(Suppl 4): A52-A53.
26.	Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitantCox-maze Ⅲ procedure using an argon-based cryosurgical system: A single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
27.	Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
28.	Arnaz A, Güllü AÜ, Akyol A, et al. Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results. Turk Gogus Kalp Damar Cerrahisi Derg, 2018, 26(1): 8-13.
29.	Jeong DS, You JH, Jeon CS, et al. Impact of ablation duration on rhythm outcome after concomitant maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30.	Cai W, Hu J, Wang H, et al. Valve surgery in combination with cryoablation in the treatment of atrial fibrillation. Pak J Med Sci, 2018, 34(6): 1402-1407.

1. Lip GYH, Collet JP, Caterina R, et al. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: A joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace, 2017, 19(11): 1757-1758.
2. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议(2018). 中国心律失常学杂志, 2018, 22(4): 279-344.
3. Morin DP, Bernard ML, Madias C, et al. The state of the art: Atrial fibrillation epidemiology, prevention, and treatment. Mayo Clin Proc, 2016, 91(12): 1778-1810.
4. Banerjee A, Allan V, Denaxas S, et al. Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: Phenotypes, population prevalence, trends and prognosis. Europace, 2019, 21(12): 1776-1784.
5. Esteves AF, Brito D, Rigueira J, et al. Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center. Rev Port Cardiol, 2018, 37(12): 991-998.
6. Ad N, Holmes SD, Massimiano PS, et al. Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2018, 155(3): 983-994.
7. Wang H, Han J, Wang Z, et al. Efficacy of cut-and-sew surgical ablation for atrial fibrillation in patients with giant left atria undergoing mitral valve surgery: A propensity-matched analysis. Semin Thorac Cardiovasc Surg, 2019, 31(4): 796-802.
8. 韩劲松, 王辉山, 汪曾炜, 等. Cox迷宫Ⅲ型手术治疗风湿性二尖瓣病变伴发心房颤动的安全性和有效性. 中华医学杂志, 2016, 96(13): 1011-1015.
9. 韩劲松, 王辉山, 汪曾炜, 等. 倾向性评分法评价迷宫Ⅲ手术治疗退行性二尖瓣病变合并房颤的安全性和疗效. 中华胸心血管外科杂志, 2017, 33(8): 466-471.
10. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
11. Curiel-Balsera E, Mora-Ordoñez JM, Castillo-Lorente E, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care, 2013, 28(4): 397-404.
12. Badhwar V, Rankin JS, Damiano RJ Jr, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
13. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
14. Mizrahi EH, Fleissig Y, Arad M, et al. Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients. Arch Gerontol Geriatr, 2014, 58(1): 121-124.
15. 马超, 王辉山, 韩劲松, 等. 瓣膜性心房颤动冷冻消融迷宫Ⅳ术后心房收缩功能恢复规律分析. 中国胸心血管外科临床杂志, 2020, 27(9): 1045-1054.
16. 韩劲松, 王辉山, 尹宗涛, 等. 两种人工瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全的比较. 中国组织工程研究, 2015, 19(16): 2578-2582.
17. Lombard FW, Liang Y. Risk factors for mitral valve surgery: Atrial fibrillation and pulmonary hypertension. Semin Cardiothorac Vasc Anesth, 2019, 23(1): 57-69.
18. Gillinov M, Soltesz EG. Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity. J Thorac Cardiovasc Surg, 2018, 155(3): 995-996.
19. Ad N, Damiano RJ, Badhwar V, et al. Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(6): 1330-1354.
20. Gomes GG, Gali WL, Sarabanda AVL, et al. Late results of Cox Maze Ⅲ procedure in patients with atrial fibrillation associated with structural heart disease. Arq Bras Cardiol, 2017, 109(1): 14-22.
21. Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze Ⅳ procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(1): 159-170.
22. Labin JE, Haque N, Sinn LA, et al. The Cox-Maze Ⅳ procedure for atrial fibrillation is equally efficacious in patients with rheumatic and degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2017, 154(3): 835-844.
23. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
24. 韩博, 于建波, 朱恩军, 等. 高龄患者心脏瓣膜手术联合冠状动脉旁路移植术发生院内死亡的危险因素分析. 实用医院临床杂志, 2017, 14(2): 36-39.
25. Hothi S, Tan D, MacDonald W, et al. Does intervention of severe valve lesions always improve cardiac function. Heart, 2015, 101(Suppl 4): A52-A53.
26. Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitantCox-maze Ⅲ procedure using an argon-based cryosurgical system: A single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
27. Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
28. Arnaz A, Güllü AÜ, Akyol A, et al. Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results. Turk Gogus Kalp Damar Cerrahisi Derg, 2018, 26(1): 8-13.
29. Jeong DS, You JH, Jeon CS, et al. Impact of ablation duration on rhythm outcome after concomitant maze procedure using cryoablation in patients with persistent atrial fibrillation. J Cardiothorac Surg, 2017, 12(1): 60.
30. Cai W, Hu J, Wang H, et al. Valve surgery in combination with cryoablation in the treatment of atrial fibrillation. Pak J Med Sci, 2018, 34(6): 1402-1407.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation: A propensity-score matching study

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