title: Results of the Cox-Maze III/IV procedure in patients over 75 years old who present for cardiac surgery with a history of atrial fibrillation.
abstract: OBJECTIVE
  Elderly patients with atrial fibrillation (AF) present a special challenge. Despite the documented advantage in ablating AF, the addition of the procedure may add complexity and potentially impact patient outcome. This study explored the impact of the Cox-Maze III/IV procedure on elderly patients experiencing AF who present for cardiac surgery.
  
  
  METHODS
  Forty-four patients aged ≥ 75 with concomitant surgery underwent the Cox-Maze III/IV procedure for AF. These patients were followed using our extensive longitudinally designed registry to include health related quality of life (HRQL). Late death was captured by the Social Security Index and the National Death Index.
  
  
  RESULTS
  The mean age for this sample was 79.5 ± 3 years and mean additive euroSCORE was 9 ± 2.1 (high risk). The majority of patients with the Cox-Maze procedure underwent concomitant valve surgery (N. = 41, 93%). There was a low incidence of STS measured perioperative outcomes in this group. NSR rates at six months were 90% (26/29) and 85% (23/27) at 12 months for the ablation group. There were no embolic strokes and major bleeding events occurred in only two patients. By Kaplan-Meier analysis, two-year cumulative survival was 89.6% and there was only one operative mortality in this group (2.3%).
  
  
  CONCLUSIONS
  Addition of the Cox-Maze III/IV procedure in patients ≥ 75 years may add to the complexity of the surgical procedure, but does not increase the operative risk. Age should not be the only discriminating factor when considering the Cox-Maze III/IV procedure for patients aged ≥ 75 years who present for cardiac surgery while experiencing atrial fibrillation.
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA 22042, USA. niv.ad@inova.org
authors.forename: N
authors.initials: N
authors.lastname: Ad
authors.forename: L
authors.initials: L
authors.lastname: Henry
authors.forename: S
authors.initials: S
authors.lastname: Hunt
authors.forename: S D
authors.initials: SD
authors.lastname: Holmes
authors.forename: L
authors.initials: L
authors.lastname: Halpin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D015996:Survival Rate