Long-term results of the maze procedure in patients with mechanical valve

Background: The advantage of the Maze procedure concomitant with the mechanical valve implantation is unclear. This study evaluated the long-term results of mechanical valve implantation either alone or concomitant with the Maze procedure. Methods: Between 1990 and 2005, 208 patients underwent mitral valve replacement with a mechanical valve. Maze procedure was concomitantly performed in 77 patients, and 54 of these had restored sinus rhythm (Maze group). The other 131 patients did not perform the Maze procedure (non-Maze group). Survival and late outcomes were studied retrospectively with univariate analysis (logrank test), and a case-matched study by propensity score was performed. The late New York Heart Association (NYHA) functional status obtained by questionnaire and the cardiac function observed by echocardiography were studied for comparison of the two groups. Results: Survival and late outcomes, except for bleeding, were not significantly different between the groups, and this was also true of the case-matched study. In the NYHA functional status, the Maze group had more class I patients, while the non- Maze group has more class II patients. The left ventricular ejection fraction, left atrial enlargement, and tricuspid regurgitation were not significant factors affecting the differences between class I and II patients. Conclusions: The Maze procedure is considered to be worth for patients who need life-long anticoagulation for the mechanical valve because it improves the NYHA functional status.