Left atrial maze procedure using diathermy and high-frequency ultrasound as an adjunct to mitral valve replacement in mitral valve disease with atrial fibrillation: a comparative study

Abstract

Purpose

Mitral valve disease is often complicated with atrial fibrillation (AF). Conventional treatment for AF has now been replaced by various energy sources. Our purpose was to evaluate a cost-effective and efficient energy source for performing the Maze procedure. We evaluated and compared diathermy and high-frequency ultrasound as energy source to create maze lines, in terms of outcome.

Methods

Forty patients with mitral valve disease requiring mitral valve replacement and in atrial fibrillation were included in the study. Twenty patients underwent the Maze procedure using diathermy and 20 using high-frequency ultrasound (Harmonic scalpel probe). All Maze lines were made endocardially from within the cavum of the left atrium isolating the pulmonary veins. All patients were assessed by standard 12 lead electrocardiogram (ECG) in the postoperative period as well as in each follow up visit. Left atrial appendage was ligated in those having left atrium (LA) clot.

Results

Sinus rhythm was restored in 95% of patients in the immediate postop period in diathermy group as compared to 90% in the high-frequency ultrasound group. At 3 months, 90% were in sinus rhythm in the diathermy group and 85% in the high frequency ultrasound (HFU) group. Statistically significant differences between groups were observed in the following variables: cardiopulmonary bypass (CPB) time ( p = 0.011), cross clamp time ( p = 0.019), maze time ( p = 0.00), and in hospital stay ( p = 0.05).

Conclusion

Both energy sources were safe, time sparing, effective, and simple; however, the diathermy took less time to perform maze than the HUF and the total CPB time and cross clamp time was less in the diathermy group.