title: Concomitant MAZE procedure during cardiac surgical procedures: is there any survival advantage in conversion to sinus rhythm?
abstract: OBJECTIVE
  The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently.
  
  
  METHODS
  We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2 ± 12.0 years and 52.2% were female (N. = 109). Perioperative mortality was 5.74% (N. = 12).
  
  
  RESULTS
  In univariate analysis, significant risk factors for perioperative mortality were age (P = 0.0033), duration of perfusion time (P = 0.0093), elevated creatinine (≥ 1.6 mg/dL, P = .02), and cross clamp time (P = 0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88% ± 2.2%, and 76% ± 3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N. = 154) were 88% ± 2.6% and 80% ± 3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N. = 55) were 94% ± 3% and 82% ± 6.6%, respectively, this survival difference was not statistically significant (P = 0.24). Significant risk factors for long-term mortality included DM (P = 0.023), preoperative MI (P = 0.043), preoperative renal insufficiency (creatinine, ≥ 1.6 mg/dL, P = 0.02) and asthma/COPD (P = 0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality.
  
  
  CONCLUSIONS
  The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA - siyamekneragi@yahoo.com.
authors.forename: S
authors.initials: S
authors.lastname: Neragi-Miandoab
authors.forename: E
authors.initials: E
authors.lastname: Skripochnik
authors.forename: R E
authors.initials: RE
authors.lastname: Michler
authors.forename: P
authors.initials: P
authors.lastname: Friedman
authors.forename: D A
authors.initials: DA
authors.lastname: D'Alessandro
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome