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Published on: February 26, 2013
Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience
H V Schaff1, J A Dearani, R C Daly
1Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Insights
The Cox-Maze procedure effectively treats atrial fibrillation in most patients, restoring sinus rhythm and improving cardiac function. This surgical intervention reduces risks associated with blood clots and bleeding, enhancing overall patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia impacting quality of life and increasing risks of stroke and bleeding.
- The Cox-Maze procedure is a surgical treatment for AF aiming to restore sinus rhythm and atrioventricular synchrony.
Purpose of the Study:
- To evaluate the efficacy and safety of the Cox-Maze procedure in a large patient cohort.
- To assess outcomes in patients with concomitant cardiac conditions and explore modifications like right atrial incisions.
Main Methods:
- Retrospective analysis of 221 Cox-Maze procedures performed between March 1993 and March 1999.
- Inclusion of patients with various cardiac diseases, including those requiring concomitant operations and valvuloplasty.
Main Results:
- Successful sinus rhythm restoration in approximately 90% of patients.
- Low early mortality (1.4%) and low pacemaker implantation rate (3.2%).
- Positive outcomes observed with simplified right atrial incisions and combined procedures for mitral valve regurgitation; no early deaths in 87 combined cases.
Conclusions:
- The Cox-Maze procedure is highly effective for treating atrial fibrillation, with significant improvements in symptoms and reduction in thromboembolic risk.
- The procedure is safe, even in patients with complex cardiac disease and ventricular dysfunction.
- Restoration of sinus rhythm positively impacts left ventricular ejection fraction.
Abstract:
The Cox-Maze procedure corrects atrial fibrillation in 90% of patients, and successful operation restores sinus rhythm, thereby reducing risks of thromboembolism and anticoagulant-associated hemorrhage. Symptoms such as palpitation and fatigability also improve with restoration of atrioventricular synchrony. At the Mayo Clinic, 221 Cox-Maze procedures were performed from March 1993 through March 1999. Over 75% of patients had associated cardiac disease and concomitant operations. Overall, early mortality was 1.4%, and the incidence of postoperative pacemaker implantation was 3.2%. Limiting incisions to the right atrium simplifies the operation for patients who primarily have tricuspid valve disease, and in early follow-up, outcome appeared to be as good as that achieved with biatrial incisions. The Cox-Maze procedure has proved particularly useful for patients with preoperative atrial fibrillation who require valvuloplasty for acquired mitral valve regurgitation; 87 patients have had this combined procedure, and there have been no early deaths. Further, our experience indicates that ventricular dysfunction is not a contraindication for operation and that restoration of sinus rhythm after the Cox-Maze procedure improves left ventricular ejection fraction in most patients.
