Abstract 12329: Does the Maze Procedure Prevent Strokes over the Long Term After Surgery?
Background: The Maze procedure is the golden standard surgical therapy for atrial fibrillation (AF). Although the effects of the Maze procedure are relief of symptoms and improvement in the cardiac function, the most important purpose of this procedure is prevention of strokes after surgery. The objective of this study was to determine the AF cure ratio and incidence of strokes during the two decades following the Maze procedure.
Methods: Between November 1994 and May 2013, 360 consecutive patients that underwent AF surgery (Maze procedure in 309, pulmonary vein isolation (PVI) in 30, right atrial Maze + PVI in 13, and left atrial Maze in 8). Cryo or radiofrequency ablation devices were used to create conduction block during the AF surgery in 80 and 280 patients, respectively. The average age was 64±10 years old. The mode of preoperative AF was longstanding persistent in 256 patients and paroxysmal in 104.
Two-hundred-ninety patients (81%) had valvular heart disease, and only 32 (9%) had lone AF. The complete medical records, postoperative electrocardiograms and Holter records were examined for all episodes of AF. Follow-up was conducted by telephone interviews with the referring cardiologists and patients.
Results: AF was cured in 90% of patients at the time of hospital discharge after the AF surgery. The operative mortality was 1.7%. In 61 patients with over 10 years’ of postoperative follow-up, 75% remained AF free. By 19 years after the AF surgery, 65% of the patients were AF free. The AF free ratio in the paroxysmal AF patients was significantly higher than that in the longstanding persistent AF patients by 15 years after the AF surgery (95% vs. 65%; p≤0.01). There was no significant difference in the AF cure ratio between cryo and radiofrequency Maze procedures. Pacemakers were implanted in 35% of the patients by the final checkup. Postoperative atrial tachycardia occurred in 7% of the patients. Although 146 patients (41%) were free from anticoagulant therapy postoperatively, only 5 of all patients (1.4%) had strokes after the AF surgery.
Conclusions: The Maze procedure is effective for curing AF over the long term. This procedure is able to prevent strokes without any anticoagulant therapy for at least two decades after the surgery.
- © 2013 by American Heart Association, Inc.