Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation

N. Handa, Hartzell V Schaff, J. J. Morris, B. J. Anderson, S. L. Kopecky, Maurice E Sarano

Research output: Contribution to journalArticle

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Abstract

Objective: The objective was to determine whether the Cox maze procedure provides adjunctive benefit in patients with atrial fibrillation undergoing mitral valve repair. Methods: We compared the outcome of 39 patients who had the Cox maze procedure plus mitral valve repair between January 1993 and December 1996 (maze group) with that of 58 patients with preoperative atrial fibrillation who had mitral valve repair during the same interval by the same surgeons (control group). Patients in the 2 cohorts were similar for age, gender, preoperative New York Heart Association class III or IV, and duration of preoperative atrial fibrillation. The control group had a higher incidence of previous heart surgery and coronary artery disease. Results: No operative deaths occurred, and 1 patient in each group required pacemaker implantation after the operation. Duration of cardiopulmonary bypass (122 ± 40 minutes vs 58 ± 27 minutes, P < .0001) and hospitalization (12.6 ± 6.4 vs 9.3 ± 3.4 days, P < .0025) were prolonged in patients having the Cox maze procedure. Overall, 2-year survival was similar (92% ± 5% for maze patients and 96% ± 3% for controls). Freedom from atrial fibrillation in the maze group was 74% ± 8% 2 years after the operation compared with 27% ± 7% for the control group (P < .0001). Freedom from stroke or anticoagulant-associated bleeding in the maze group was 100% 2 years after the operation compared with 90% ± 8% in the control group (P = .04). At most recent follow-up, 82% of maze patients were in normal sinus rhythm (53% in control group). Conclusion: The addition of the Cox maze procedure to mitral valve repair is safe and effective for selected patients, and elimination of atrial fibrillation decreased late complications.

Original languageEnglish (US)
Pages (from-to)628-635
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume118
Issue number4
DOIs
StatePublished - 1999

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Mitral Valve Insufficiency
Atrial Fibrillation
Mitral Valve
Control Groups
Cardiopulmonary Bypass
Anticoagulants
Thoracic Surgery
Coronary Artery Disease
Hospitalization
Stroke
Hemorrhage
Survival
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. / Handa, N.; Schaff, Hartzell V; Morris, J. J.; Anderson, B. J.; Kopecky, S. L.; Sarano, Maurice E.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 118, No. 4, 1999, p. 628-635.

Research output: Contribution to journalArticle

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AU - Kopecky, S. L.

AU - Sarano, Maurice E

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N2 - Objective: The objective was to determine whether the Cox maze procedure provides adjunctive benefit in patients with atrial fibrillation undergoing mitral valve repair. Methods: We compared the outcome of 39 patients who had the Cox maze procedure plus mitral valve repair between January 1993 and December 1996 (maze group) with that of 58 patients with preoperative atrial fibrillation who had mitral valve repair during the same interval by the same surgeons (control group). Patients in the 2 cohorts were similar for age, gender, preoperative New York Heart Association class III or IV, and duration of preoperative atrial fibrillation. The control group had a higher incidence of previous heart surgery and coronary artery disease. Results: No operative deaths occurred, and 1 patient in each group required pacemaker implantation after the operation. Duration of cardiopulmonary bypass (122 ± 40 minutes vs 58 ± 27 minutes, P < .0001) and hospitalization (12.6 ± 6.4 vs 9.3 ± 3.4 days, P < .0025) were prolonged in patients having the Cox maze procedure. Overall, 2-year survival was similar (92% ± 5% for maze patients and 96% ± 3% for controls). Freedom from atrial fibrillation in the maze group was 74% ± 8% 2 years after the operation compared with 27% ± 7% for the control group (P < .0001). Freedom from stroke or anticoagulant-associated bleeding in the maze group was 100% 2 years after the operation compared with 90% ± 8% in the control group (P = .04). At most recent follow-up, 82% of maze patients were in normal sinus rhythm (53% in control group). Conclusion: The addition of the Cox maze procedure to mitral valve repair is safe and effective for selected patients, and elimination of atrial fibrillation decreased late complications.

AB - Objective: The objective was to determine whether the Cox maze procedure provides adjunctive benefit in patients with atrial fibrillation undergoing mitral valve repair. Methods: We compared the outcome of 39 patients who had the Cox maze procedure plus mitral valve repair between January 1993 and December 1996 (maze group) with that of 58 patients with preoperative atrial fibrillation who had mitral valve repair during the same interval by the same surgeons (control group). Patients in the 2 cohorts were similar for age, gender, preoperative New York Heart Association class III or IV, and duration of preoperative atrial fibrillation. The control group had a higher incidence of previous heart surgery and coronary artery disease. Results: No operative deaths occurred, and 1 patient in each group required pacemaker implantation after the operation. Duration of cardiopulmonary bypass (122 ± 40 minutes vs 58 ± 27 minutes, P < .0001) and hospitalization (12.6 ± 6.4 vs 9.3 ± 3.4 days, P < .0025) were prolonged in patients having the Cox maze procedure. Overall, 2-year survival was similar (92% ± 5% for maze patients and 96% ± 3% for controls). Freedom from atrial fibrillation in the maze group was 74% ± 8% 2 years after the operation compared with 27% ± 7% for the control group (P < .0001). Freedom from stroke or anticoagulant-associated bleeding in the maze group was 100% 2 years after the operation compared with 90% ± 8% in the control group (P = .04). At most recent follow-up, 82% of maze patients were in normal sinus rhythm (53% in control group). Conclusion: The addition of the Cox maze procedure to mitral valve repair is safe and effective for selected patients, and elimination of atrial fibrillation decreased late complications.

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