ObjectiveTo investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF).MethodsWe retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared.ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05).ConclusionMaze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.
ObjectiveTo investigate the prognostic value of the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) for all-cause mortality after left ventricular assist device (LVAD) implantation, and to provide evidence for optimizing preoperative risk stratification and perioperative management in LVAD patients. MethodsClinical data were retrospectively collected from patients undergoing LVAD implantation at Zhengzhou 7th People's Hospital between April 21, 2021, and August 24, 2025. The optimal cutoff value of TAPSE/PASP was determined using receiver operating characteristic (ROC) curve analysis, and patients were grouped accordingly. Kaplan-Meier curves were used to compare postoperative cumulative survival rates between groups. Multivariate Cox proportional hazards regression models were applied to identify independent predictors of all-cause mortality. ResultsA total of 61 patients were enrolled, including 44 males and 17 females with a median age of 56 (42, 60) years. Patients were divided into a group A (TAPSE/PASP<0.396, n=43) and a group B (TAPSE/PASP≥0.396, n=18) based on the optimal cutoff value of 0.396. Group A exhibited higher median right ventricular fractional area change (40% vs. 33%, P<0.001), ratio of right ventricular fractional area change to PASP (1.214 vs. 0.615, P<0.001), and preoperative left ventricular end-diastolic diameter (77 mm vs. 69 mm, P=0.006). Conversely, group A showed lower TAPSE/PASP ratio (0.333 vs. 0.508, P<0.001), PASP (34 mm Hg vs. 52 mm Hg, P<0.001), diastolic pulmonary artery pressure (13 mm Hg vs. 29 mm Hg, P<0.001), mean pulmonary artery pressure (21 mm Hg vs. 34 mm Hg, P=0.001), and preoperative central venous pressure (5.5 mm Hg vs. 11.0 mm Hg, P=0.002). Additionally, group A had higher incidence of tricuspid valve repair/replacement (55.8% vs. 27.8%, P=0.046) and shorter median survival time (96 days vs. 212 days, P=0.007). Median follow-up duration was 157 (56, 227) days. Log-rank analysis demonstrated significantly lower survival rate in the group A compared to group B (P=0.009). Multivariate Cox regression analysis identified TAPSE/PASP as an independent predictor for all-cause mortality after LVAD implantation [HR=0.001, 95%CI (0.001, 0.003), P=0.005]. The ROC curve demonstrated an area under the curve of 0.740 for TAPSE/PASP in predicting postoperative all-cause mortality. ConclusionTAPSE/PASP effectively evaluates right ventricular-pulmonary artery coupling status and serves as an independent prognostic factor for all-cause mortality following LVAD implantation. This parameter provides important guidance for preoperative risk assessment and perioperative management in LVAD candidates.