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Is It Conceivable to Still Perform the Cut and Sew Cox Maze III Procedure in the Current Era?

Fernando A Atik1, Gustavo G Gomes2, Fillipe F Rodrigues1

  • 1Department of Cardiovascular Surgery.

Seminars in Thoracic and Cardiovascular Surgery
|July 18, 2018
PubMed

Insights

The Cox maze III procedure for atrial fibrillation is safe when combined with other heart surgeries, showing low mortality and good rhythm outcomes. Increased procedure complexity did not worsen safety, except for a higher need for pacemakers.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Atrial fibrillation is a common arrhythmia often requiring surgical intervention.
  • The Cox maze III procedure is a standard surgical treatment for atrial fibrillation.
  • Its safety in conjunction with other open-heart procedures needs ongoing evaluation.

Purpose of the Study:

  • To assess the safety and efficacy of the Cox maze III procedure when performed with other cardiac surgeries.
  • To evaluate the impact of surgical complexity on safety endpoints.

Main Methods:

  • A retrospective analysis of 113 adult patients undergoing Cox maze III procedure with other cardiac surgeries between 2008 and 2015.
  • Data collected included patient demographics, procedure details, and perioperative outcomes.
  • Statistical analysis to correlate the number of associated procedures with morbidity and mortality.

Main Results:

  • Hospital mortality was 1.77%, with low rates of re-exploration (0.9%), stroke (1.8%), and acute renal failure (2.6%).
  • Sinus rhythm was maintained in 88% at 6 and 12 months, and 85% at 24 months.
  • Increased number of associated procedures did not correlate with poorer safety outcomes, except for a higher requirement for permanent pacemakers (18.2% with 3 procedures vs. 4% with 2).

Conclusions:

  • The cut and sew Cox maze III procedure is a safe and effective treatment for atrial fibrillation in patients with structural heart disease, even when combined with other complex cardiac surgeries.
  • Surgical complexity, indicated by the number of concomitant procedures, did not compromise safety endpoints, with the exception of an increased need for permanent pacemaker implantation.

Keywords:
Atrial fibrillationCardiovascular surgeryRheumatic fever

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