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Ann Thorac Surg 2009;87:1452-1459. doi:10.1016/j.athoracsur.2009.02.008
© 2009 The Society of Thoracic Surgeons
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James S. Gammie
Ann J. Toran
Bartley P. Griffith
Thomas J. Vander Salm
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Right arrow Electrophysiology - arrhythmias

Original Articles: Adult Cardiac

Intermediate-term Outcomes of Surgical Atrial Fibrillation Correction with the CryoMaze Procedure

James S. Gammie, MDa,*, Parijat Didolkar, MDa, Leandra S. Krowsoski, ABa, Mary J. Santos, PA-Ca, Ann J. Toran, MDb, Cindi A. Younga, Bartley P. Griffith, MDa, Stephen R. Shorofsky, MDa, Thomas J. Vander Salm, MDb

a Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland
b North Shore Medical Center, Salem, Massachusetts

Accepted for publication February 3, 2009.

* Address correspondence to Dr Gammie, Division of Cardiac Surgery, University of Maryland Medical Center, N4W94, 22 S Greene St, Baltimore, MD 21201 (Email: jgammie{at}smail.umaryland.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008

Background: Few studies have reported long-term outcomes of surgical atrial fibrillation (AF) correction. We perform the Cox-Maze III lesion set with argon-powered cryoenergy (CryoMaze procedure) on all patients with AF presenting for cardiac operations. This study reports long-term clinical results and heart rhythm status.

Methods: Between July 2002 and November 2005, 119 consecutive patients underwent surgical AF correction with the CryoMaze procedure. Mitral valve disease was the primary indication for operation in 66%. AF was continuous in 65%. Rhythm assessment was with 2-week continuous electrocardiographic (ECG) monitoring in 75% of patients and by noncontinuous ECG in the remainder. Median follow-up was 3.2 years and was 98% complete.

Results: There was one hospital (0.8%) death. Survival at 3 years was 84%. One perioperative stroke resolved completely. No late strokes occurred. In 4 of 119 patients (4 (3.4%), pacemakers were inserted during the index hospitalization. Median length of stay was 7 days. Overall freedom from AF more than 3 years after operation was 60%. Among patients with preoperative intermittent AF, 85% (28 of 33) were in normal sinus rhythm, and 47% (27 of 58) with continuous AF were in normal sinus rhythm (p < 0.001).

Conclusions: CryoMaze AF correction is safe and is associated with a very low risk of stroke. Rates of normal sinus rhythm at more than 3 years postoperatively were high for patients with intermittent AF and acceptable for those with continuous AF. This experience supports wider application of the CryoMaze to all patients with AF who need cardiac operations.






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