Abstract 3251: The Cox-Maze Procedure for the Treatment of Lone Atrial Fibrillation: A Twenty-Year Experience
Background: The Cox-Maze procedure (CMP) was introduced in 1987 for the surgical treatment of atrial fibrillation (AF). This operation has achieved high cure rates and has become progressively less invasive. This report describes the largest single institutional experience for the treatment of lone AF and compares the outcomes of the original “cut and sew” CMP to the more simplified bipolar radiofrequency ablation (RFA) procedure which has been performed since 2002.
Material and Methods: A retrospective review of 214 patients (mean age: 52 ± 11 years) who underwent Cox-Maze procedure for lone AF from September 1987 through May 2007, was performed. Mean duration of preoperative AF was 8.8 ± 8.1 years. Sixty-two percent of patients had paroxysmal and 38% had persistent or permanent AF. Patients were distributed in two cohorts: original cut and sew (n = 153) and bipolar RFA (n = 61). Data were analyzed by means of univariate analysis with preoperative and perioperative variables used as covariates. A Kaplan-Meier analysis for freedom from symptomatic AF recurrence and antiarrhythmic drug use was performed.
Results: The overall operative mortality was 1.4%. Median hospital length of stay (LOS) was 9 days (4 –53). Mean follow-up was 4.9 ± 4.0 years. Freedom from AF at 1, 5, and 10 years was 97.5%, 95.4%, and 89.6%, respectively. Freedom from AF off antiarrhythmics at 1 and 5 years was 89.6% and 82.1%, respectively. There was only one late stroke. At last follow-up, 75% of patients were on no anticoagulation therapy. The CMP using RFA had a significantly shorter cross-clamp time than the cut-and-sew procedure (41 ± 14 vs. 86 ± 25 minutes respectively, p < 0.001). The median hospital LOS was 2 days shorter (p = 0.07) for the RFA procedure. There was no significant difference in late freedom from AF between the two procedures.
Conclusions: The Cox-Maze procedure has had excellent success rates for lone AF at late follow-up, while virtually eliminating the risk of stroke. The majority of patients were able to discontinue warfarin. Bipolar RFA has simplified and shortened the procedure, while preserving its efficacy.