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Long-Term Outcomes of Concomitant Modified Cox-Maze and Mitral Surgery

Choosak Kasemsarn1, Pramote Porapakkham1, Sahaporn Wathanawanichakun1

  • 1Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|March 25, 2025
PubMed

Insights

Combined Maze and mitral valve surgery effectively manages atrial fibrillation (AF) and mitral disease. Achieving sinus rhythm (SR) post-surgery reduces neurological complications, though recurrence predictors include AF duration and left atrial size.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Electrophysiology
  • Thoracic Surgery

Background:

  • Limited long-term data exists for combined Maze and mitral valve procedures.
  • Atrial fibrillation (AF) management alongside mitral valve disease requires effective surgical solutions.

Purpose of the Study:

  • To evaluate the long-term efficacy of combined Maze and mitral valve surgery.
  • To identify predictors of AF recurrence and factors influencing survival after the procedure.

Main Methods:

  • Analysis of 406 patients undergoing mitral surgery with concomitant Maze procedure (June 2004 - December 2022).
  • Assessment of rhythm outcomes, AF recurrence predictors, and overall survival.
  • Median follow-up of 100 months.

Main Results:

  • Freedom from AF at 15 years was 52.7%.
  • Sinus rhythm (SR) patients had fewer neurological complications compared to those in AF (p=0.001).
  • Predictors of AF recurrence included longer AF duration, left atrial diameter >50 mm, tricuspid valve surgery, and early postoperative AF.

Conclusions:

  • Combined Maze and mitral valve surgery offers significant benefits for patients with AF and mitral disease.
  • Early identification of recurrence predictors like AF duration and left atrial size is crucial.
  • Maintaining SR post-surgery is associated with improved neurological outcomes.
Abstract

Keywords:
atrial fibrillationlong-term outcomemodified Maze proceduresurgical biatrial RF ablation

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