Related Experiment Video
Updated: Feb 16, 2026
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation
Niv Ad1, Sari D Holmes2, Paul S Massimiano3
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa; Washington Adventist Hospital, Takoma Park, Md; Inova Fairfax Hospital, Falls Church, Va.
Insights
The Cox maze (CM) procedure combined with mitral valve surgery is safe and effective for treating atrial fibrillation (AF). This approach significantly reduces stroke risk and improves rhythm control long-term.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) increases morbidity and mortality after valve surgery.
- Concomitant procedures are necessary for complex cases.
Purpose of the Study:
- To evaluate the long-term effectiveness of the Cox maze (CM) procedure combined with mitral valve surgery.
- To assess freedom from atrial arrhythmia and stroke after concomitant procedures.
Main Methods:
- A cohort of 473 patients underwent CM and mitral valve procedures.
- Rhythm status, medication, and clinical events were tracked for up to 7 years.
Main Results:
- Perioperative stroke and mortality were low (0.4% and 2.7%, respectively).
- Rhythm success (sinus rhythm) was 66% at 7 years, with 55% off antiarrhythmic drugs.
- Freedom from embolic stroke at 7 years was 96.6%, with most patients off anticoagulation.
Conclusions:
- Adding the CM procedure to mitral valve surgery does not increase operative risk.
- CM demonstrates acceptable long-term rhythm success, reduced AF burden, and a low stroke rate.
- Surgeon experience is a key factor in the long-term success of surgical ablation for AF.
Objective:
Atrial fibrillation (AF) is associated with increased early and long-term morbidity/mortality following valve surgery. This study examined long-term influence of concomitant full Cox maze (CM) and mitral valve procedures on freedom from atrial arrhythmia and stroke.
Methods:
This sample comprised patients who underwent CM with a mitral valve procedure (N = 473). Data on rhythm, medication status, and clinical events captured according to Heart Rhythm Society guidelines at 6, 9, 12, 18, and 24 months and yearly thereafter up to 7 years.
Results:
Mean age was 65 years, mean left atrium size was 5.3 cm, and 15% had paroxysmal AF. Perioperative stroke occurred in 2 patients (0.4%) and operative mortality was 2.7% (n = 13). Return to sinus rhythm regardless of antiarrhythmic drugs at 1, 5, and 7 years was 90%, 80%, and 66%. Sinus rhythm off antiarrhythmic drugs at 1, 5, and 7 years was 83%, 69%, and 55%. Freedom from embolic stroke at 7 years was 96.6% (0.4 strokes per 100 patient-years) with a majority of patients off anticoagulation medication. Greater odds of atrial arrhythmia recurrence during 7 years was associated with longer AF duration (odds ratio [OR], 1.07; P = .001), whereas lower odds were associated with cryothermal energy only (OR, 0.64; P = .045) and greater surgeon experience (OR, 0.98; P = .025).
Conclusions:
This study suggests that the addition of CM to mitral valve procedures, even with a high degree of complexity, did not increase operative risk. In long-term follow-up, the CM procedure demonstrated acceptable rhythm success, reduced AF burden, and remarkably low stroke rate. Individual surgeon experience and training may notably influence long-term surgical ablation for AF success.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:22Mitral Stenosis I: Introduction
01:25Mitral Regurgitation III: Medical Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Mitral Valve Prolapse II: Assessment and Management
01:27Mitral Stenosis IV: Nursing Management