{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:21:57Z","timestamp":1790144517727,"version":"4.0.1"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002509","name":"Keimyung University","doi-asserted-by":"publisher","award":["20240648"],"award-info":[{"award-number":["20240648"]}],"id":[{"id":"10.13039\/501100002509","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Although the concomitant Maze procedure successfully restores sinus rhythm in patients with valvular atrial fibrillation, it remains unclear whether electrical restoration translates into uniform functional recovery across different valvular etiologies. To address this issue, we compared the long-term left atrial (LA) mechanical recovery between patients with mitral stenosis (MS) and mitral regurgitation (MR) after the Maze procedure. Methods: This retrospective study included 211 patients who underwent the Maze procedure concomitant with valvular surgery and maintained sinus rhythm after 1 year. Patients were stratified into three groups, namely MS (n = 51), MR (n = 98), and non-mitral (n = 62) serving as a reference. LA function was evaluated using speckle-tracking echocardiography at baseline, immediately postoperatively, and at 1 year. Primary outcomes were changes in LA reservoir (LASr), LA conduit (LAScd), and LA contractile (LASct) strains. Results: At 1-year follow-up, the non-mitral reference group exhibited the best LA function, followed by the MR group, whereas the MS group showed the most impaired values (p &lt; 0.001). Analysis of functional recovery revealed a mechanistic divergence, i.e., although the improvement in passive stiffness (LAScd) was comparable between the MS and MR groups (p = 0.42), the recovery of active contractile strain (LASct) was significantly superior in the MR group compared to the MS group (p &lt; 0.05). The MS group failed to regain effective atrial contraction despite successful rhythm control. Conclusions: Although the Maze procedure successfully restored sinus rhythm, functional recovery varied significantly by etiology. The superior recovery in patients with MR was driven by the restoration of active atrial contraction, whereas patients with MS exhibited persistent mechanical dysfunction attributed to irreversible myocardial structural remodeling, despite similar improvements in compliance. Therefore, electrical success does not guarantee functional success, particularly in patients with MS.<\/jats:p>","DOI":"10.3390\/jcm15051856","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"1856","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Mitral Valvular Etiology on Left Atrial Functional Recovery After the Maze Procedure: A Comparison Between Mitral Stenosis, Mitral Regurgitation and Non-Mitral Valve Disease"],"prefix":"10.3390","volume":"15","author":[{"given":"Woo Sung","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2855-9756","authenticated-orcid":false,"given":"Jung Uk","family":"Woo","sequence":"additional","affiliation":[{"name":"School of Medicine, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungsub","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. 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