# Optimal patient selection for maze procedure in patients undergoing mitral valve disease

## TL;DR

This study evaluates how selecting patients for the Maze procedure based on intraoperative cardioversion improves outcomes in patients with mitral valve disease.

## Contribution

The study introduces a novel patient selection method for Maze procedures based on intraoperative cardioversion and identifies specific predictors for successful outcomes.

## Key findings

- F-wave ≥ 0.1 mV was a significant predictor for disappearance of atrial fibrillation.
- Left atrial diameter ≤ 55 mm was a significant predictor for A-wave detection.
- Intraoperative DC after ventricular unloading was effective for selecting patients for Maze procedures.

## Abstract

Although risk factors for unsuccessful Maze procedure have been demonstrated, an appropriate patient selection is still controversial. In our institute, Maze procedure is indicated for those whom normal sinus rhythm (NSR) was reestablished by intraoperative direct cardioversion (DC) after ventricular unloading by total cardiopulmonary bypass. The purpose of this study was to evaluate the effectiveness of our indication criteria for Maze procedure in patients with mitral valve disease.

Between October 2012 and October 2021, MAZE was indicated in 55 patients in whom normal sinus rhythm (NSR) was reestablished by intraoperative direct current cardioversion (DC). Three endpoints and predictors were examined: disappearance of atrial fibrillation (AF), NSR, and A-wave detection.

Restoration of NSR by intraoperative DC was confirmed in 43 patients, and these patients underwent MAZE. AF disappeared in 39 patients (90.7%), and F-wave ≥ 0.1 mV was a significant predictive factor (odds ratio (OR) 20.99, 95% CI 1.22–1079.06). NSR was reestablished in 36 patients (83.7%), and F-wave ≥ 0.1 mV (odds ratio 15.62, 95% CI 1.62–359.86) + AF history ≤ 3 years (OR 8.30, 95% CI 1.09–177.04) were significant predictors. A-wave detection was confirmed in 26 patients (60.5%), and left atrial diameter ≤ 55 mm was a significant predictor (OR 5.22, 95% CI 1.28–24.79).

Intraoperative DC after ventricular unloading resulted effective patient selection for concomitant Maze procedure. F-wave and AF history were predictive factor of electrical restoration of AF, and left atrial diameter was predictive factor of restoration of atrial function.