Mid‐term outcomes of concomitant Cox‐Maze IV: Results from a multicenter prospective registry

Abstract

Background: Benefits of concomitant atrial fibrillation (AF) surgical treatment are well established. Cardiac societies support treating AF during cardiac surgery with a class I recommendation. Despite these guidelines, adoption has been inconsistent.We report results of routine performance of concomitant Cox-Maze IV (CMIV) from participating centers using a standardized, prospective registry.Methods: Nine surgeons at four cardiac surgery programs enrolled 807 patients undergoing concomitant CMIV surgery over 12 years. Lesions were created using bipolar radiofrequency clamps and cryoablation probes. Follow-up occurred at 3-and 6-months, then annually for 3 years. Freedom from AF was defined as no episode >30 s of atrial arrhythmia.Results: Sixty-four percent of patients were male, mean age 69 years, mean left atrial size 4.6 cm, mean preoperative AF duration 4.0 years, mean EuroSCORE 6.4, and mean CHADS 2 score 3.1. Thirty-day postoperative mortality and neurologic event rates were 3.3% and 1.3%, respectively. New pacemaker implant rate was 6.3%. Freedom from AF rates at 1-and 3-years stratified by preoperative AF type were: paroxysmal 94.6% and 87.5%, persistent 82.1% and 81.9%, and longstanding persistent 84.1% and 78.1%. At 3-year follow up, 84% of patients were off antiarrhythmic drugs and 74% of sinus rhythm patients were off oral anticoagulants.Conclusions: Routine CMIV is safe and effective. Acceptable outcomes can be achieved across multiple centers and multiple operators even in a moderate risk patient population undergoing more complex procedures. Surgeons and institutions should be encouraged by all cardiac societies to adopt the CMIV procedure to maximize patient benefit.

Concomitant Surgical Ablation for Treatment of Atrial Fibrillation in Patients Undergoing Minimally Invasive Mitral Valve Surgery: A Single-Center Experience in Vietnam

“…Despite these authors performing open surgery, our results demonstrate that good outcomes can be achieved even with minimally invasive surgery. [14][15][16] In numerous studies, the use of Cordarone (amiodarone) for 3 months following surgical ablation of AF has shown a significant reduction in AF recurrence. 17,18 In our practice, patients were prescribed Cordarone for up to 3 months after surgery, with discontinuation occurring in case of drugrelated complications or after the 3-month period.…”

“…This result highlights the effectiveness of the current treatment, specifically the Cox-maze IV procedure, in managing AF with low pacemaker complications. 14 The recommendations in the ESC and ACC guidelines were followed in our clinical practice. 1,2 Left atrial appendage closure and conventional anticoagulation therapy for 3 months were administered to all patients.…”

Surgical options for atrial fibrillation treatment during concomitant cardiac procedures

“…A lower incidence amongst patients listed for coronary artery bypass graft (CABG) is found, at approximately 5% ( 3 ). Prior studies have illustrated that concomitant surgical AF ablation alongside valvular surgery and/or CABG promotes sinus rhythm (SR) restoration and improves long-term outcomes, with demonstrated safety and effectiveness ( 4 - 7 ), while patients with untreated AF experienced a lower quality of life due to the persistence of arrhythmia-related symptoms and reduced exercise tolerance ( 8 ). Notwithstanding the clear benefits and guideline recommendations, concomitant AF ablation is still under-performed in patients with AF undergoing cardiac surgery ( 9 , 10 ).…”

Concomitant arrhythmia surgery should be a standard procedure in AF patients undergoing cardiac surgery

“…Another very good example of its efficacy is the present report “Midterm Outcomes of Concomitant Cox‐Maze IV: Results from a Multicenter Prospective Registry,” in which Gerdisch and colleagues describe their results from a routine performance of a standardized Cox‐Maze IV (CMIV) procedure concomitant to cardiac surgery 6 . In total, 807 patients were analyzed from four cardiac centers over 12 years.…”

“…5 Another very good example of its efficacy is the present report "Midterm Outcomes of Concomitant Cox-Maze IV: Results from a Multicenter Prospective Registry," in which Gerdisch and colleagues describe their results from a routine performance of a standardized Cox-Maze IV (CMIV) procedure concomitant to cardiac surgery. 6 In total, 807 patients were analyzed from four cardiac centers over 12 years. All patients received a biatrial lesion set, as described previously, 7 concomitant to CABG (15%), aortic valve replacement (9%), mitral valve repair or replacement (22%), or a combination of CABG/valve/multivalve (42%).…”