The mid-term outcome of the Cox maze III procedure and complex concomitant cardiac surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Atrial fibrillation is a common arrhythmia often managed separately from other cardiac surgeries.
• Many surgeons avoid maze procedures during complex cardiac operations.
• The Cox maze III procedure offers a potential solution for concurrent atrial fibrillation treatment.

Purpose of the Study:

• To evaluate the safety and efficacy of the Cox maze III procedure when performed concurrently with other complex cardiac surgeries.
• To assess the impact of this combined approach on atrial fibrillation control.

Main Methods:

• A cohort of 40 patients (mean age 56 years) with persistent or permanent atrial fibrillation underwent the Cox maze III procedure alongside other cardiac surgeries.
• Patient data, including pre-operative atrial fibrillation duration and follow-up duration (22-82 months), were analyzed.
• Outcomes assessed included mortality, re-operations, pacemaker dependency, and freedom from atrial fibrillation.

Main Results:

• The 30-day mortality was 2.5%, with low rates of re-operation (5%) for bleeding or other complications.
• Late mortality was also 2.5%, and 14% of patients required postoperative pacemakers.
• Crucially, 97% of patients achieved freedom from atrial fibrillation post-procedure.

Conclusions:

• The Cox maze III procedure can be safely and effectively integrated into complex cardiac surgery.
• This combined approach demonstrates excellent long-term control of atrial fibrillation.
• The findings support the routine consideration of the Cox maze III procedure in appropriate cardiac surgery patients.