Concomitant MAZE procedure during cardiac surgical procedures: Is there any survival advantage in conversion to sinus rhythm?

Aim. The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently. Methods. We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2% were female (N.=109). Perioperative mortality was 5.74% (N.=12). Results. In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality. Conclusion. The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.