Assessment of thromboembolism after the Cox-Maze procedure for chronic atrial fibrillation secondary to mitral valve lesion.
OBJECTIVE
To assess the occurrence of late thromboembolism after surgical repair of chronic atrial fibrillation (AF) simultaneously with repair of mitral valve using the Cox-Maze procedure.


METHODS
69 patients underwent Cox 3 procedure, with no cryoablation simultaneously with mitral valvuloplasty or prosthesis. Mean age was 49.9+/-13.2 years. Mean follow-up was of 31.7+/-19 months. Types of lesion were as follows: 33 (48%) stenoses, 23 (33%) insufficiencies, and 13 (19%) double lesions. Procedures were: 64 (93%) valvuloplasties, 3 (4%) biological and 2 (3%) mechanical prosthesis placement. There were 9 (13%) patients with previous systemic embolism and 2 (3%) had left atrial thrombi.


RESULTS
Early mortality was 7% and late 1%. 2 patients (3%) were reoperated for mitral placement. At last evaluation, 10 patients (15%), were in AF. The remaining 59 (85%) were either in sinus / atrial rythm (74%) or under pacing (12%). There were no occurrence of early or late, systemic or pulmonary embolism. Permanent anticoagulation was employed in 16 cases, 10 in regular rythm and 6 in AF. The remaining 47 (75%), 2 in AF and 45 in regular rythm, did not receive anticoagulants.


CONCLUSIONS
These results are in accordance with others series, where the occurrence of embolism was rare after maze procedure. Permanent systemic anticoagulation seems to be unnecessary in those cases.
Kalil
Renato A K
RA
Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, SP, Brasil.
Nesralla
Paula L M
PL
Lima
Gustavo G
GG
Leiria
Tiago L
TL
Abrahao
Rogério
R
Moreno
Paulo
P
Prates
Paulo R
PR
Sant'Anna
João R M
JR
Nesralla
Ivo A
IA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology*