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Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease
Gustavo Gir Gomes1,2, Wagner Luis Gali1,2, Alvaro Valentim Lima Sarabanda1,2
1Instituto de Cardiologia do Distrito Federal - Fundação Universitária de Cardiologia (FUC), Brasília, DF - Brazil.
Insights
The Cox-Maze III procedure effectively restores sinus rhythm in atrial fibrillation (AF) patients, demonstrating excellent long-term survival and low stroke rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Atrial Fibrillation Management
Background:
- The Cox-Maze III procedure is a surgical technique for treating atrial fibrillation (AF).
- This study evaluates the long-term efficacy and safety of the Cox-Maze III procedure.
Purpose of the Study:
- To assess the late results of the Cox-Maze III procedure regarding sinus rhythm maintenance.
- To determine mortality and stroke rates after the Cox-Maze III procedure.
Main Methods:
- Ninety-three patients underwent the Cox-Maze III procedure combined with structural heart disease repair between 2006 and 2013.
- Heart rhythm was monitored using 24-hour Holter monitoring; recurrence predictors were analyzed using multivariate Cox regression.
Main Results:
- Eighty patients with a mean follow-up of 27.5 months showed sinus rhythm maintenance rates of 88% at 6 months, 85.1% at 24 months, and 80.6% at 36 months.
- Predictors for AF recurrence included female gender, coronary artery disease, and larger left atrium diameter.
- Actuarial survival was 98.5%, and freedom from stroke was 97.5% at 48 months.
Conclusions:
- The Cox-Maze III procedure is effective in maintaining sinus rhythm for patients with atrial fibrillation.
- The procedure is associated with very low long-term mortality and stroke rates.
Background:
Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF).
Objectives:
To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates.
Methods:
Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models.
Results:
Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames.
Conclusions:
The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates.
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