Late outcomes after the Cox maze IV procedure for atrial fibrillation

Abstract

OBJECTIVE The Cox-Maze IV procedure (CMPIV) has been established as the gold standard for surgical ablation, however late outcomes using current consensus definitions of treatment failure have not been well described. In order to compare to reported outcomes of catheter-based ablation, we report our institutional outcomes of patients who underwent a left-sided or biatrial CMPIV at five years of follow up. METHODS Between January 2002 and September 2014, data were collected prospectively on 576 patients with AF who underwent a CMPIV(n= 532) or left-sided CMPIV(n= 44). Perioperative variables and long-term freedom from AF on and off AADs were compared in multiple subgroups. RESULTS Follow up at any time point was 89%. At five years, overall freedom from AF was 78% (93/119) and freedom from AF off AADs was 66% (77/177). There were no differences in freedom from AF on or off AADs at 1, 2, 3, 4, and 5 years between patients with paroxysmal AF(n=204) and patients with persistent/long-standing persistent AF(n=305), or between those who underwent stand-alone and those who received a concomitant CMP. Duration of preoperative AF and hospital length of stay were the best predictors of failure at 5 years. CONCLUSIONS The outcomes of the CMPIV remain good at late follow up. The type of preoperative AF or the addition of a concomitant procedure did not affect late success. The results of the CMPIV remain superior to those reported for catheter ablation and other forms of surgical AF ablation, especially for patients with persistent or long-standing AF.

Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery

“…In our study, hospital mortality was 4.4%, which is a good result, comparable to those of other authors, representing the experience of treatment of such cohort of patients in current literature [8][9][10].…”

Successful anticoagulation therapy for a giant left atrial thrombus following mitral valve repair

“…The LA thrombus which occurred in our patient may have been partly precipitated by his persistent AF, especially in the setting of a newly implanted mitral annuloplasty ring. As his AF was longstanding and the LA was severely dilated (>6 cm in diameter), we opted against performing a concomitant maze procedure, in view of the limited success rate of achieving durable sinus rhythm in the presence of these poor prognostic factors (9).…”

Surgical ablation is effective: But surgeons need to do better

“…Since then, its many iterations and the evolution of minimally invasive approaches have helped to make the surgery safer and more widely accepted. In this issue of the Journal , Henn and colleagues 1 report their long-term outcomes with the “Cox maze IV procedure.” Their study included 576 consecutive patients from their institution treated with either biatrial or left atrial lesion sets by sternotomy or minimally invasive approaches; most of these patients underwent concomitant cardiac procedures.…”

“…Henn and colleagues 1 are strong proponents of surgical ablation to treat atrial tachyarrhythmias (ATAs), and with good reason. Patients with AF undergoing cardiac surgery have increased mortality relative to propensity-matched control subjects without AF.…”

“…1 There have been, however, several randomized trials that are noteworthy. The Atrial Fibrillation Catheter Ablation versus Surgical Ablation Treatment (FAST) trial 3 demonstrated superior freedom from ATAs without the need for antiarrhythmic drugs (AADs) with surgical relative to catheter ablation (65.6% vs 36.5%; P = .0022) in a population of patients with lone AF.…”