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Ann Thorac Surg 2006;82:1758-1764
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Left Atrial Reduction Enhances Outcomes of Modified Maze Procedure for Permanent Atrial Fibrillation During Concomitant Mitral Surgery

Cardiac Surgical Associates MAZE Investigators, Tampa-St. Petersburg, Florida

Accepted for publication May 11, 2006.

^_* Address correspondence to Dr Badhwar, Cardiac Surgical Associates, Tampa Bay Heart Institute, 6006 49th St N, Suite 310, St. Petersburg, FL 33701 (Email: vbadhwar{at}heartsurgery-csa.com).

Presented at Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: Success of the maze procedure after mitral operations with large left atria and permanent atrial fibrillation remains suboptimal. Current technique variations tend to obscure the decision-making algorithm in these patients. A single energy-source approach for the surgical management of patients with large left atria and permanent atrial fibrillation is presented.

METHODS: From January 2003 to July 2005, 71 consecutive drug-resistant patients with permanent atrial fibrillation and left atrial enlargement who required mitral valve surgery underwent aggressive left atrial reduction combined with left-sided only irrigated radiofrequency unipolar maze. Left atrial dimensions were measured by transesophageal echo anterior-to-posterior leading edge-to-edge standardized protocol. There were 39 men (54.9%) and 32 women (45.1%), and their mean age was 71.9 ± 9.5 years. Mean duration of atrial fibrillation was 49.3 ± 58.0 months.

RESULTS: All patients underwent left atrial reduction with identical Cox-maze III pulmonary vein and appendage isolation including mitral annular connection, followed by appendage suture closure. Left atrial size was reduced from 6.7 ± 1.2 cm to 4.3 ± 0.6 cm (p = 0.001). Mitral valve repair was performed in 55 patients (76.1%) and replacement in 17 (23.9%). The 30-day mortality was 4.2% (3/71). Postoperative length of stay was 8.8 ± 5.7 days, with 56 (82.4%) of 68 patients discharged in normal sinus rhythm. P-wave sinus rhythm was 93.8% between 7 and 12 months and 92.0% for patients with 1 year or more of follow-up.

CONCLUSIONS: Left atrial reduction combined with a left atrial only single energy-source radiofrequency maze procedure is an effective treatment for patients with permanent atrial fibrillation undergoing concomitant mitral operations.

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