The Long-term Outcomes of Concomitant Cox-Maze IV Procedure in Patients with Mitral Valve Disease and Atrial Fibrillation.

Abstract

Background: The most common indication worldwide for surgical ablation of atrial fibrillation (AF) is patients referred for mitral valve surgery. However, few reports have described late outcomes. This study examined ten-year outcomes in AF patients undergoing mitral surgery with and without concomitant Cox-Maze IV Procedure.

Methods: Since January 2002, 847 patients with AF and mitral valve disease underwent either mitral surgery with a concomitant Cox-Maze IV Procedure (CMP-IV) (N = 407) or without (N = 440). The concomitant sub-groups, paroxysmal (N = 163) and non-paroxysmal AF (N = 244), were compared for freedom from tachyarrhythmias, and recurrence-free survival. Late survival was compared after propensity score-matching analysis.

Results: The concomitant procedure provided good freedom from atrial tachyarrhythmias of 80% and 65% at years 5 and 10 respectively. The freedom from symptomatic AF recurrence was 94% and 83%, respectively. Although there was no difference between atrial tachyarrhythmia recurrence free survival between subgroups in the concomitant cohort (P = .13), there was a trend toward worse rhythm outcomes (P = .053) in patients with nonparoxysmal AF. Ten-year survival in the propensity-matched concomitant CMP-IV cohort was 54% (versus 43% without ablation), which represented a significant survival benefit in patients having concomitant ablation (P = .007).

Conclusions: Cox-Maze IV procedure had good long-term outcomes in treating AF in patients undergoing mitral surgery and provided a significant survival benefit in patients receiving a concomitant ablation. There is recurrence in over 40% of patients at 10 years, indicating the need for continued rhythm follow-up.