ABSTRACT
BACKGROUND AND AIM OF STUDY
To evaluate outcomes of concurrent Cox-Maze procedures in elderly
patients undergoing high-risk cardiac surgery.
MEHODS
We retrospectively identified patients aged over 70 years with Atrial
Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac
procedures. They were subdivided into two groups:
1. Cox-Maze IV AF ablation
2. No-Surgical AF treatment.
Patients requiring redo procedures or those who had isolated PVI or LAAO
were excluded. Heart rhythm was assessed from Holter reports or 12-lead
ECG. Follow-up data collected through telephone consultations and
medical records.
RESULTS
There were 239 patients. Median follow up was 61 months. 70 patients had
Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative
outcomes were similar between the groups although duration of
pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%)
patient in Cox maze group with 30-day mortality compared to 14 (8.2%)
the control group (p=0.05). Sinus rhythm at annual and latest follow-up
was 84.9% and 80.0% respectively in Maze group - significantly better
than No-Surgical AF treatment groups (P<0.001). 160 patients
(66.9%) were alive at long-term follow-up with better survival curves
in Cox Maze group compared to No-Surgical treatment group (p=0.02).
There were a significantly higher proportion of patients in NYHA 1
status in Cox-Maze group (p=0.009). No differences observed in freedom
from stroke (p=0.80) or permanent pacemaker (p=0.33).
CONCLUSIONS.
Surgical ablation is beneficial in elderly patients undergoing high-risk
surgery - promoting excellent long-term freedom from AF and
symptomatic/prognostic benefits. Therefore, surgical risk need not be a
reason to deny benefits of concomitant AF-ablation.