5. Conclusions
This systematic review found that concomitant Cox-Maze in AF patients undergoing MV surgery is associated with a strong tendency of better mid-term freedom from AF when compared to PVI with comparable mid-term postoperative survival outcomes. Large observational studies suggested that there might be a mid-term survival benefit for patients undergoing concomitant Cox-Maze procedure, although large multicenter RCT are still needed to assess the long-term survival benefit of Cox-Maze procedure. Successful intraoperative ablation of AF improves outcomes and thus the ideal operation would correct both MV dysfunction and AF.
Ethical approval: Not directly applicable since this is a review article.
Author contributions: DS: conceptualization, formal analysis, investigation, methodology, validation, resources, writing – original draft, critical revision and approval of the article. VT, SGR: conceptualization, formal analysis, validation, resources, supervision, writing – reviewing and editing, critical revision and approval of the article. JH: conceptualization, formal analysis, validation, resources. MT: validation, supervision, writing – reviewing and editing, critical revision and approval of the article.