title: Mini-maze suffices as adjunct to mitral valve surgery in patients with preoperative atrial fibrillation.
abstract: BACKGROUND
  After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach limits general appliance. We investigated the clinical outcome of a simplified, less extensive Cox maze procedure ("mini-maze") as adjunct to MV surgery.
  
  
  RESULTS
  Thirteen patients with MV disease and preoperative AF were treated with combined surgery (group 1). Nine control patients without previous AF underwent isolated MV surgery (group 2). We retrospectively compared the results to findings in 23 patients with preoperative AF who had undergone isolated MV surgery (group 3). In group 1, mini-maze took an additional 46 minutes of perfusion time. One 75-year-old patient died of postoperative multiple organ failure. Seven patients showed spontaneously converting (within 2 months) postoperative AF. After 1 year, 82% were in sinus rhythm (SR). No sinus node dysfunction was observed. In group 2, all patients were in SR after 1 year. In group 3, only 53% were in SR after 1 year, despite serial cardioversion and antiarrhythmic drug therapy. Exercise tolerance and heart rate were comparable for groups 1 and 2. Left atrial function was present in all but one patient in group 1 and in all patients in group 2 (after MV reconstruction).
  
  
  CONCLUSIONS
  Adding a relatively simple mini-maze to MV surgery improves arrhythmia outcome in patients with preoperative AF without introducing sinus node dysfunction or persistent absence of left atrial function. The results of this type of combined surgery are encouraging and deserve further attention.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Tuinenburg
authors.forename: I C
authors.initials: IC
authors.lastname: Van Gelder
authors.forename: R G
authors.initials: RG
authors.lastname: Tieleman
authors.forename: J G
authors.initials: JG
authors.lastname: Grandjean
authors.forename: R C
authors.initials: RC
authors.lastname: Huet
authors.forename: J M
authors.initials: JM
authors.lastname: van der Maaten
authors.forename: E G
authors.initials: EG
authors.lastname: Pieper
authors.forename: P J
authors.initials: PJ
authors.lastname: De Kam
authors.forename: T
authors.initials: T
authors.lastname: Ebels
authors.forename: H J
authors.initials: HJ
authors.lastname: Crijns
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome