title: [Safety and efficacy of Cox-maze Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease].
abstract: OBJECTIVE
  To evaluate the safety and efficacy of cut-and-sew Cox-Maze (CM) Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease.
  
  
  METHODS
  Patients received mitral valve replacement and CM procedure between January 2007 and July 2015, were 1∶1 matched and assigned to CM Ⅳ group (undergoing surgical ablation) and CM Ⅲ group (undergoing cut-and-sew CM Ⅲ). Safety indices, mortality rate, complications and recovery rate of sinus rhythm were compared between the two groups.
  
  
  RESULTS
  Mean extracorporeal circulation time was (154±22) min in the CM Ⅲ group and (136±21) min in the CM Ⅳ group (P<0.001), and aortic clamp time was (85±9) min in the CM Ⅲ group and (74±12) min in the CM Ⅳ group (P<0.001). One patient (1.18%) in the CM Ⅲ group died of multi-organ failure 4 day after left ventricular rupture being sucessfully repaired, and 2 patients died (2.35%) in the CM Ⅳ group ( 1 due to left ventricular rupture and 1 due to low cardiac output syndrome). There was no significant difference in mortality between the two groups. Temporary pacemaker were applied for 76 cases (89.41%) in the CM Ⅲ and 70 cases (82.35%) in the CM Ⅳ group, without a statistical difference (P=0.186). There were also no statistical difference between the two groups in intraoperative urinary volume, postoperative drainage of fluid volume, hemoglobinuria, ventilator time, ICU time, hospital stay and the incidence of the complications (all P>0.05). Sinus rhythm recovery rate was 62.35 % in the CM Ⅲ group and 57.65 % in the CM Ⅳ group, without a statistical difference (P=0.531) at the operation day, but at discharge a statistical difference was found (97.62% in the CM Ⅲ group vs 81.93% in the CM Ⅳ group, P<0.001). All patients were followed up for three months, and no deaths occurred. Sinus rhythm recovery rate was 96.43 % in the CM Ⅲ group and 86.75% in the CM Ⅳ group, with a statistical difference (P=0.024).
  
  
  CONCLUSIONS
  The cut-and-sew Cox-Maze Ⅲ procedure is a safe and effective method for patients with atrial fibrillation associated with rheumatic mitral valve disease.
authors.affiliation: Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
authors.forename: J S
authors.initials: JS
authors.lastname: Han
authors.forename: H S
authors.initials: HS
authors.lastname: Wang
authors.forename: Z W
authors.initials: ZW
authors.lastname: Wang
authors.forename: Z T
authors.initials: ZT
authors.lastname: Yin
authors.forename: H G
authors.initials: HG
authors.lastname: Han
authors.forename: C Y
authors.initials: CY
authors.lastname: Tang
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008943:Mitral Valve / Q000601:surgery; D010138:Pacemaker, Artificial; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000601:surgery; D012449:Safety; D016896:Treatment Outcome