title: Association of operative risk with the outcome of concomitant Cox Maze procedure: a comparison of results across risk groups.
abstract: OBJECTIVE
  Cardiac surgery patients with atrial fibrillation face increased risks for perioperative morbidity and decreased survival, yet only 39% of patients presenting with atrial fibrillation undergo concomitant surgical ablation. This low percentage may relate to the perception of lower yield for surgical ablation, especially in patients with complex clinical presentations. In this study, we compared outcomes after a concomitant Cox maze III/IV procedure in patients with high, intermediate, and low predicted operative risk.
  
  
  METHODS
  Outcome data were prospectively captured after surgery. The additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) was greater than 6 for high-risk patients (n = 145), 3 or less for low-risk patients (n = 76), and greater than 3 and 6 or less for intermediate-risk patients (n = 149).
  
  
  RESULTS
  No differences were found for perioperative morbidities, including operative mortality (high vs low risk, 2% vs 1%, P = 1.00; high vs intermediate risk, 2% vs 0.7%, P = .37). Median length of stay was longer in high-risk patients versus low-risk patients (8 vs 5 days, P < .001) and intermediate-risk patients (8 vs 6 days, P < .001). Return to sinus rhythm was comparable for high-risk versus low- and intermediate-risk patients at 6, 12, and 24 months. Physical health-related quality of life scores improved similarly for all groups at 12 months. No difference in long-term survival was found (log rank = 0.40; P = .82).
  
  
  CONCLUSIONS
  The Cox maze III/IV procedure can be performed safely and effectively in patients with higher operative risk, who fare well when compared with lower-risk patients. The Cox maze III/IV procedure should be considered carefully in patients with a significant history of atrial fibrillation.
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Va. Electronic address: Niv.Ad@inova.org.
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Va.
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Va.
authors.forename: Graciela
authors.initials: G
authors.lastname: Pritchard
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Va.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Shuman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome