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The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease

K B Kim1, K R Cho, D W Sohn

  • 1Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Korea.

The Annals of Thoracic Surgery
|October 6, 1999
PubMed

Insights

The Cox-Maze III procedure effectively restores sinus rhythm in patients with rheumatic mitral valve disease and atrial fibrillation, showing high success rates even in reoperations.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Rheumatic mitral valve disease often coexists with atrial fibrillation (AF).
  • Surgical outcomes for Cox-Maze III (CM-III) procedure in rheumatic mitral valve disease (RMVD) patients are less favorable than for AF alone.
  • Assessing CM-III efficacy in this specific patient group is crucial.

Purpose of the Study:

  • To evaluate the efficacy and safety of the Cox-Maze III procedure when combined with rheumatic mitral valve surgery.
  • To determine the success rate of restoring normal sinus rhythm in patients with AF and RMVD.
  • To analyze operative risks and long-term outcomes, including atrial contractility.

Main Methods:

  • Retrospective analysis of 75 patients undergoing CM-III and rheumatic mitral valve procedures (April 1994 - December 1997).
  • Included 14 reoperation cases due to prosthetic valve failure.
  • Follow-up averaged 30 months, assessing sinus rhythm restoration and atrial contractility via echocardiography.

Main Results:

  • High sinus conversion rate of 90.4% (66/73 survivors) was achieved.
  • In-hospital mortality was 2.7% (2/75).
  • Both right and left atrial contractility were restored, though left atrial contractility recovery was slower and less frequent.

Conclusions:

  • The Cox-Maze III procedure is a safe and effective treatment for atrial fibrillation in patients with rheumatic mitral valve disease.
  • The procedure demonstrates a high sinus conversion rate and acceptable operative risk, even in reoperative cases.
  • Restoration of atrial contractility is achievable, supporting the procedure's utility in this complex patient population.
Abstract

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