Surgical concepts for atrial fibrillation in patients with concomitant mitral valve disease

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.