The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation.
OBJECTIVE
The Cox maze procedure is the gold standard for ablation of atrial fibrillation in patients undergoing mitral valve surgery, and new approaches to atrial fibrillation ablation must be compared with it. Therefore, we sought to determine the time-related prevalence of atrial fibrillation and its risk factors after combined Cox maze and mitral valve surgery.


METHODS
From November 1991 through January 2004, 263 patients (mean left atrial diameter, 5.8 +/- 1.2 cm) underwent combined mitral valve surgery (repair in 71%) and a cut-and-sew Cox maze procedure for atrial fibrillation (permanent, 74%; persistent, 7%; paroxysmal, 16%). Rhythm documented on 2367 postoperative electrocardiograms was used to estimate the prevalence of atrial fibrillation across time.


RESULTS
Hospital mortality was 1.9%. Postoperative atrial fibrillation prevalence peaked at 36% at 2 weeks, decreasing to 21% at 5 years. Risk factors for higher postoperative atrial fibrillation prevalence varied with time and included longer duration of preoperative atrial fibrillation (P = .003), larger left atrial diameter (P = .01), older age (P = .0002), and higher left ventricular mass index (P = .02).


CONCLUSIONS
In some patients undergoing mitral valve surgery and a Cox maze procedure, atrial fibrillation recurs over time, mandating close, long-term follow-up of heart rhythm. Earlier operation and left atrial size reduction should be considered to improve results in selected patients.
Gillinov
A Marc
AM
Center for Atrial Fibrillation and the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. gillinom@ccf.org
Sirak
Jon
J
Blackstone
Eugene H
EH
McCarthy
Patrick M
PM
Rajeswaran
Jeevanantham
J
Pettersson
Gosta
G
Sabik
F Joseph
FJ
Svensson
Lars G
LG
Navia
Jose L
JL
Cosgrove
Delos M
DM
Marrouche
Nassir
N
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence