The mid-term outcome of the Cox maze III procedure and complex concomitant cardiac surgery

Ulf Lockowandt

doi:10.1080/14017430600788401

January 1, 2006Scandinavian Cardiovascular Journal

The mid-term outcome of the Cox maze III procedure and complex concomitant cardiac surgery

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Why the study?

Does the Cox maze III procedure safely and effectively prevent atrial fibrillation when added to complex concomitant cardiac surgery?

Structured PICO

Does the Cox maze III procedure safely and effectively prevent atrial fibrillation when added to complex concomitant cardiac surgery?

P

Population

40 patients (27 men), aged 36 to 76 years, with atrial fibrillation (82% permanent, others persistent or paroxysmal) and pre-operative AF duration of 0.5 to 39 years, undergoing complex concomitant cardiac surgery.

I

Intervention

Full Cox maze III operation performed in combination with other cardiac surgery.

O

Outcome

Freedom from atrial fibrillation and 30-day mortality.hard clinical

The Cox maze III procedure can be safely and effectively performed concomitantly with complex cardiac surgery, achieving 97% freedom from atrial fibrillation at mid-term follow-up.

Implication

Supports feasibility in complex cases; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

OBJECTIVE: Many surgeons do not deal with atrial fibrillation or choose modifications of the maze procedure when performing additional cardiac surgery. The Cox maze III procedure as an adjunct to other sometimes very complex cardiac surgery was examined. DESIGN: 40 patients (27 men), 36 to 76 years, underwent a full Cox maze III operation in combination with other cardiac surgery, reflecting the case mix of a modern practice. Permanent fibrillation was presented by 82%, the others suffering from persistent or paroxysmal fibrillation. Pre-operative duration of atrial fibrillation was 0.5 to 39 years. Follow-up was 22 to 82 months. RESULTS: The 30-day mortality was 2.5%; there was one case of intra aortic balloon-pump, two re-operations because of bleeding (5%), and one re-operation because of systolic anterior motion of the anterior mitral leaflet. Follow-up was 95% complete. Late mortality was 2.5%. Five patients (14%) required postoperative pacemakers. Freedom of atrial fibrillation was 97%. CONCLUSION: The addition of the Cox maze III procedure to other sometimes very complex cardiac surgery is safe and efficient in controlling atrial fibrillation.