The long-term outcomes of concomitant Cox-Maze IV procedure in patients with mitral valve disease and atrial fibrillation.

Abstract

The most common indication worldwide for surgical ablation of atrial fibrillation (AF) is patients referred for mitral valve surgery. However, few reports have described late outcomes. This study examined 10-year outcomes in patients with AF undergoing mitral surgery with and without a concomitant Cox-Maze IV procedure (CMP-IV). Since January 2002, 847 patients with AF and mitral valve disease underwent either mitral surgery with a concomitant CMP-IV (n = 407) or without (n = 440). The concomitant subgroups, paroxysmal (n = 163) and nonparoxysmal AF (n = 244), were compared for freedom from tachyarrhythmias and recurrence-free survival. Late survival was compared after propensity score-matching analysis. The concomitant procedure provided good freedom from atrial tachyarrhythmias of 80% and 65% at years 5 and 10, respectively. The freedom from symptomatic AF recurrence was 94% and 83%, respectively. Although there was no difference between atrial tachyarrhythmia recurrence-free survival between subgroups in the concomitant cohort (P = .13), there was a trend toward worse rhythm outcomes (P = .053) in patients with nonparoxysmal AF. Ten-year survival in the propensity-matched concomitant CMP-IV cohort was 54% (vs 43% without ablation), which represented a significant survival benefit in patients having concomitant ablation (P = .007). CMP-IV had good long-term outcomes in treating AF in patients undergoing mitral surgery and provided a significant survival benefit in patients receiving a concomitant ablation. There is recurrence in over 40% of patients at 10 years, indicating the need for continued rhythm follow-up.