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Updated: Jul 12, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
[Surgical concepts for atrial fibrillation in patients with concomitant mitral valve disease]
R N Komarov1, D A Matsuganov2, M D Nuzhdin2
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Insights
The Cox-maze IV procedure demonstrated superior outcomes compared to Cox-maze III, with shorter aortic cross-clamping times and reduced postoperative bleeding. Both maze procedures effectively restored sinus rhythm in patients undergoing concomitant mitral valve surgery.
Area of Science:
- Cardiac Surgery
- Electrophysiology
- Atrial Fibrillation Ablation
Context:
- Atrial fibrillation (AF) is a common arrhythmia often requiring surgical intervention.
- Concomitant mitral valve surgery is frequently performed with AF ablation procedures.
- Evaluating advancements in surgical ablation techniques is crucial for improving patient outcomes.
Purpose:
- To compare the in-hospital results of the Cox-maze III and Cox-maze IV procedures when performed with mitral valve surgery.
- To assess the efficacy and safety of these two surgical ablation techniques.
Summary:
- This propensity score-matched study compared Cox-maze III (n=15) and Cox-maze IV (n=14) procedures in patients with AF undergoing mitral valve surgery.
- The Cox-maze IV group showed significantly reduced aortic cross-clamping time, mechanical ventilation duration, and postoperative drainage.
- No in-hospital mortality occurred in either group, and sinus rhythm recovery was similarly high for both procedures.
Impact:
- The Cox-maze IV procedure offers potential advantages in reducing surgical trauma and improving early postoperative recovery.
- These findings support the adoption of the Cox-maze IV technique for patients requiring surgical AF ablation.
- Further research should explore long-term outcomes and cost-effectiveness of the Cox-maze IV procedure.
Objective:
To analyze in-hospital results after «Cox-maze III» and «Cox-maze IV» procedures with concomitant mitral valve surgery.
Material And Methods:
This study included patients who underwent «Cox-maze III» and «Cox-maze IV» procedures between January 2015 and February 2022. We distinguished 2 groups using propensity score matching: «Cox-maze III» group (n=15), «Cox-maze IV» group (n=14). All patients had preoperative atrial fibrillation: paroxysmal (3 (10.3%) patients), persistent (5 (17.2%)) and long-standing persistent (21 (72.4%) patients). Mean duration of AF before surgery was 11 [9-60] months in both groups. We used standard statistical methods using the IBM SPSS Statistics 26.0 software package (USA).
Results:
Aortic cross-clamping time was significantly less in the «Cox-maze IV» group (p<0.001). There was no in-hospital mortality in both groups. Mean duration of mechanical ventilation was significantly less in the «Cox-maze IV» group (5 [3.5-9] vs. 14 [12-18] hours, respectively, p<0.001). Drainage output in the first postoperative day was significantly less in the «Cox-maze IV» group (295 [220-370] vs. 400 [325-500] ml, respectively, p=0.02). Temporary pacemaker was required in 73.3% and 42.8% of cases, respectively (p=0.03).
Conclusion:
We should emphasize high efficiency of sinus rhythm recovery after both procedures without significant difference (p=0.16). However, time of aortic cross-clamping, mechanical ventilation and volume of postoperative bleeding were significantly less in the «Cox-maze IV» group.
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