Cox-maze III Procedure for Atrial Fibrillation during Valve Surgery: A Single Institution Experience

Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF. Methods: A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. In this trial, we used a monopolar radiofrequency (RF) ablation in addition to cut and sew technique to treat AF. Results: 66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2±8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4±32.9 and 115.6±22.8 minutes respectively. The first 24hours drainage was 488.6±293.3ml. The postoperative hospital stay was 14.8±8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5%, 1.5%, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7%, 93.1%, 94.7%, 93.3% and 89.5% at 1, 3, 6, 12, and 24 months respectively. Conclusions: The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.