Therapeutic efficacy of Mei mini maze procedure in patients with atrial fibrillation and functional tricuspid regurgitation
10.3760/cma.j.cn112434-20250107-00009
- VernacularTitle:梅氏微创房颤消融术治疗房颤合并功能性三尖瓣反流的疗效分析
- Author:
Chao WANG
1
;
Zhaolei JIANG
1
;
Nan MA
1
;
Hao LIU
1
;
Jie CAI
1
;
Fangbao DING
1
;
Shiao DING
1
;
Ju MEI
1
Author Information
1. 上海交通大学医学院附属新华医院心胸外科，上海 200092
- Publication Type:Journal Article
- Keywords:
Functional tricuspid regurgitation;
Atrial fibrillation;
Minimally invasive surgical maze ablation;
Cardiac chamber remodeling
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2025;41(6):346-351
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the maintenance of sinus rhythm and the changes in functional tricuspid regurgitation(FTR) in patients with atrial fibrillation(AF) combined with FTR following the Mei Mini Maze Procedure, and to analyze the correlation between these two factors.Methods:We retrospectively included 180 patients with AF and FTR who underwent left-sided thoracoscopic AF ablation(the Mei Mini Maze Procedure) at Xinhua Hospital in Shanghai from January 2019 to December 2021. After propensity score matching to eliminate confounding factors, the patients were divided into two groups based on the severity of FTR before surgery: the non-significant FTR group(+ -+ +, 68 cases) and the significant FTR group(≥+ + +, 68 cases). Outpatient follow-up with 24-72 hour dynamic electrocardiogram and transthoracic echocardiography(TTE) was conducted at 3, 6, 12, 24, and 36 months post-discharge. The maintenance of sinus rhythm and changes in FTR were compared between the two groups.Results:All patients successfully completed the Mei Mini Maze Procedure. Compared to preoperative values, the severity of FTR improved in both groups. Non-significant FTR group: 59% of patients(40 cases) had no regurgitation, 27%(18 cases) had mild FTR, 11%(8 cases) had moderate FTR, and 3%(2 cases) had severe FTR; significant FTR group: 19%(n=13) had no regurgitation, 25%(17 cases) had mild FTR, 25%(17 cases) had moderate FTR, and 31%(21 cases) had severe FTR. The Kaplan-Meier(KM) curve revealed that the sinus rhythm maintenance rate at 3 years post-surgery was significantly higher in the non-significant FTR group(72.06%) than in the significant FTR group (57.35%), with a statistically significant difference( P=0.011). Multivariate analysis showed that postoperative FTR ≥ moderate( HR=11.469), preoperative significant FTR( HR=1.206), age over 65 years( HR=3.734), non-paroxysmal AF( HR=2.346), and longer AF duration( HR=1.151) were risk factors for AF recurrence in this cohort. Conclusion:The recovery of sinus rhythm in AF patients is closely related to the severity of FTR. Patients with preoperative significant FTR had a lower rate of sinus rhythm maintenance after surgery. Both preoperative and postoperative significant FTR are risk factors for AF recurrence in AF patients with FTR. Therefore, for patients with significant FTR, simultaneous treatment of FTR during the surgery, including a standard Cox-Maze Ⅳ procedure, may be more beneficial for maintaining postoperative sinus rhythm.
