A prospective randomized trial of the cut-and-sew Maze procedure in patients undergoing surgery for rheumatic mitral valve disease

Abstract

Addition of the CSM to an MVR procedure can decrease the risk of stroke or death and high sinus rhythm at 1 year without increasing the operative risk. CSM is a safe and effective approach to treating AF associated with RMVD.

A Modified Surgical Ablation for AF with Mitral Valve Surgery

“…There is no doubt that the Cox-Maze III, or the "cut-and-sew" maze (CSM), is still the gold standard for the treatment of AF associated with valvular disease. [3] Our group and other groups reported that the frequency of sinus rhythm after surgery was greater than 90% at 1 year. [3] However, the time-consuming and technically challenging nature limit the wide utilization of the CSM.…”

“…[3] Our group and other groups reported that the frequency of sinus rhythm after surgery was greater than 90% at 1 year. [3] However, the time-consuming and technically challenging nature limit the wide utilization of the CSM. Modi cations of the atrial lesion sets ensued as new energy sources were developed; bipolar radiofrequency and cryoablation replaced several of the maze III cut-and-sew lesions, and this facilitated procedure was called the Cox-Maze IV.…”

Black is the new black

“…Lee and colleagues 14 previously demonstrated a difference in late neurologic events according to technique, LAA excision being superior (0.2% vs 1.3% annualized). If one were to extrapolate, at 1year follow-up the magnitude of difference in the study by Wang and colleagues 6 is roughly double what would be expected. In light of a predominantly young population with mechanical valves, this raises more questions about anticoagulation management than about maze procedure efficacy for stroke reduction.…”

“…This is not news, because many studies have already demonstrated the safety and efficacy of CM-III in rheumatic patients, [7][8][9][10][11] some with contemporary postoperative monitoring utilizing Holter 8,9 and with even longer follow-up of anywhere from 3 to 9 years. Given the prior evidence, then, what was the rationale for the design of the study by Wang and colleagues 6 ? The authors offer 2 reasons: their prior retrospective study of a CM-IV approach with freedom from AF of 76% at 1 year and 67% at 5 years and recent data showing a 40% concomitant ablation rate in eligible patients.…”

What can we learn from a novel “Global Positioning System” in persistent atrial fibrillation?

“…At 5 years, the freedom from AF without antiarrhythmic drugs was 80% for the cut-and-sew Cox-maze III procedure, compared with 61% for other procedures, including the Cox-maze III lesion set performed with alternative energy sources. In a recent single-surgeon randomized prospective series 12 of 130 patients with rheumatic mitral disease comparing a cut-and-sew Cox-maze procedure III to no maze, there was a 90% freedom from AF in the Coxmaze III group. There was a significant survival advantage at 1 year of 94% versus 86% as result of stroke and anticoagulation problems in the no maze group.…”