Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience.
The Cox-Maze procedure corrects atrial fibrillation in 90% of patients, and successful operation restores sinus rhythm, thereby reducing risks of thromboembolism and anticoagulant-associated hemorrhage. Symptoms such as palpitation and fatigability also improve with restoration of atrioventricular synchrony. At the Mayo Clinic, 221 Cox-Maze procedures were performed from March 1993 through March 1999. Over 75% of patients had associated cardiac disease and concomitant operations. Overall, early mortality was 1.4%, and the incidence of postoperative pacemaker implantation was 3.2%. Limiting incisions to the right atrium simplifies the operation for patients who primarily have tricuspid valve disease, and in early follow-up, outcome appeared to be as good as that achieved with biatrial incisions. The Cox-Maze procedure has proved particularly useful for patients with preoperative atrial fibrillation who require valvuloplasty for acquired mitral valve regurgitation; 87 patients have had this combined procedure, and there have been no early deaths. Further, our experience indicates that ventricular dysfunction is not a contraindication for operation and that restoration of sinus rhythm after the Cox-Maze procedure improves left ventricular ejection fraction in most patients.
Schaff
H V
HV
Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Dearani
J A
JA
Daly
R C
RC
Orszulak
T A
TA
Danielson
G K
GK
D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006325:Heart Atria / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008910:Minnesota / Q000453:epidemiology; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome