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The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant
Sunil M Prasad1, Hersh S Maniar, Cindy J Camillo
1Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO 63110, USA.
Insights
The Cox maze III procedure is equally effective for lone atrial fibrillation and when performed with other heart surgeries. This standard treatment shows comparable long-term outcomes and operative risks for both patient groups.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- The Cox maze III procedure is a established treatment for atrial fibrillation.
- Efficacy in lone atrial fibrillation versus concomitant procedures is not well-defined.
Purpose of the Study:
- To compare the long-term outcomes of the Cox maze III procedure in patients with lone atrial fibrillation versus those undergoing concomitant procedures.
Main Methods:
- 198 patients underwent Cox maze III from 1988-2001 (112 lone, 86 concomitant).
- Follow-up included questionnaires and electrocardiography for arrhythmia assessment.
- Major complications were tracked.
Main Results:
- No significant difference in operative mortality (1.8% lone vs 1.2% concomitant).
- At 5.4 years follow-up, 96.6% of all patients were free of atrial fibrillation.
- Efficacy was similar between lone (95.9%) and concomitant (97.5%) groups.
Conclusions:
- The Cox maze III procedure demonstrates equivalent operative risk and long-term efficacy for both lone and concomitant procedures.
- It remains the benchmark for evaluating alternative atrial fibrillation treatments.
Background:
For the last decade, the Cox maze III procedure has been available for the treatment of atrial fibrillation. It is unknown whether the operation has similar efficacy in patients with lone atrial fibrillation compared with that in patients with atrial fibrillation associated with coronary, valve, or congenital heart disease. This study examined the long-term outcome of patients who underwent this procedure either as a lone operation or as a concomitant procedure.
Methods:
From 1988 to 2001, 198 patients underwent a Cox maze III procedure; 112 were lone operations, and 86 were concomitant procedures. Major complications included renal failure, reoperation for bleeding, mediastinitis, stroke, and balloon pump insertion. Follow-up was performed by means of mail and telephone questionnaires with both the patients and their cardiologists. All patients who had any history of arrhythmia or who were taking medication had their rhythm documented by means of electrocardiography.
Results:
The lone operation group was significantly younger (51.3 +/- 10.5 vs 58.8 +/- 9.9 years) and had a higher male/female ratio (4:1 vs 2:1). There was no difference in operative mortality between groups (1.8% vs 1.2%). At a follow-up of 5.4 +/- 2.9 years, 96.6% (172/178) of all patients were free of atrial fibrillation. There was no difference between the lone operation and concomitant procedure groups (95.9% vs 97.5%).
Conclusion:
The Cox maze III procedure has equivalent operative risk and long-term efficacy in patients undergoing both lone operations and concomitant procedures. The Cox maze III procedure remains the standard against which alternative procedures for atrial fibrillation must be judged.
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