Long-term results of the Cox-Maze III procedure for persistent atrial fibrillation associated with rheumatic mitral valve disease: 10-year experience

Kwan Chang Kim, Kwang Ree Cho, Yong Jin Kim, Dae Won Sohn, Ki Bong Kim

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35 Scopus citations

Abstract

Objective: We evaluated the long-term results of the Cox-Maze III procedure (CM-III) for persistent atrial fibrillation (AF) associated with rheumatic mitral valve (MV) disease. Methods: We analyzed 127 patients who underwent the CM-III combined with a rheumatic MV procedure between 1994 and 2004. In-hospital mortalities were excluded from the study. Results: There were 10 late deaths and the mean follow-up duration was 7.1 ± 2.8 years (range, 13 months to 11.5 years). Normal sinus rhythm was restored in 88.2% (112/127) after the CM-III. Right atrial contractility was demonstrable in 100% (112/112) and left atrial contractility in 68.8% (77/112) of the patients restored to sinus rhythm. Fifteen patients never regained sinus rhythm after the CM-III (AF treatment failure). Permanent pacemakers were implanted in 4.7% (6/127) of the patients during the follow-up. Late recurrence of AF developed in 34 of 112 patients at 44 ± 27 months postoperatively, and sinus rhythm was restored in 29 of 34 patients by administration of an antiarrhythmic medication. Independent risk factors for late AF recurrence were longer duration of AF (>60 months) (odds ratio (OR) = 2.758, p = 0.025), increased left atrial size (OR = 1.113, p = 0.004). Freedom from AF recurrence was 93% at 1-year, 82% at 3 years, 71% at 5 years, and 63% at 7 years. Risk factors for AF treatment failure were longer duration of AF (>60 months) (p < 0.001) and increased patient age (p = 0.030). A higher prevalence of significant late tricuspid regurgitation was observed in patients with AF treatment failure and those with late AF recurrence. Conclusions: The CM-III for persistent AF associated with rheumatic MV disease demonstrated a progressively decreased cure rate during the follow-up period. Early surgical therapy, aggressive left atrial reduction, and correction of tricuspid regurgitation at the time of surgery may increase the long-term success rate.

Original languageEnglish
Pages (from-to)261-266
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume31
Issue number2
DOIs
StatePublished - Feb 2007

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Maze procedure
  • Rheumatic valvular disease

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