title: Outcome of concomitantCox-maze III procedure using an argon-based cryosurgical system: a single-center experience with 250 patients.
abstract: BACKGROUND
  The Cox-Maze procedure (CM) for atrial fibrillation (AF) is associated with a high rate of sinus restoration. This study assessed the safety and efficacy of concomitant CM using an argon-based cryosurgical platform only.
  
  
  METHODS
  Data were collected prospectively for 250 consecutive patients undergoing concomitant cryosurgical CM. We examined baseline characteristics, perioperative and postoperative outcomes, health-related quality of life (Medical Outcomes Trust SF-12 Health Survey and AF Symptom Checklist) and Kaplan-Meier survival analysis.
  
  
  RESULTS
  Mean age was 64.3 ± 12.1 years, AF duration was 35.7 ± 54.2 months, left atrial size was 5.2 cm (range, 3.1 to 11.0 cm; 16.8% > 6 cm), 86% had nonparoxysmal AF, with history of cardioversion in 32% and catheter ablation in 8%. Concomitant procedures were mitral valve operation in 69.6%, coronary artery bypass graft in 29.2%, aortic valve replacement in 22.0%, with 46% multiple concomitant procedures and 16% with a previous cardiac operation. Perioperative outcomes were 5 deaths (2%), 3 strokes (1%), 1 transient ischemic attack (<1%), and 4 pacemakers for sinus node dysfunction (2%). There were no late thromboembolic events (mean follow-up, 28.2 ± 23.7 months), and 11% were taking warfarin for atrial arrhythmia at 1 year. Significant improvement in health-related quality of life (p < 0.001) was noted. At 24 months, 92.4% of patients were in sinus rhythm; with 82.8% in sinus rhythm off antiarrhythmic drugs. Two-year cumulative survival was 91%.
  
  
  CONCLUSIONS
  The cryosurgical CM procedure can be performed safely and effectively as defined by the low number of postoperative morbidities, high return to sinus rhythm off antiarrhythmic drugs, and low rate of thromboembolic events, with most patients off anticoagulation by 2 years.
authors.affiliation: Inova Heart and Vascular Institute, Cardiac Surgery Research, Falls Church, VA 22042, USA.
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.forename: Linda
authors.initials: L
authors.lastname: Henry
authors.forename: Sharon
authors.initials: S
authors.lastname: Hunt
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
mesh_terms: D000328:Adult; D000368:Aged; D001128:Argon; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001128:Argon