Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease
Abstract Background: Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF). Objectives: To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates. Methods: Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models. Results: Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames. Conclusions: The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates.
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Sociedade Brasileira de Cardiologia - SBC
2017
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oai:scielo:S0066-782X20170007000142017-07-28Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart DiseaseGomes,Gustavo GirGali,Wagner LuisSarabanda,Alvaro Valentim LimaCunha,Claudio Ribeiro daKessler,Iruena MoraesAtik,Fernando Antibas Atrial Fibrillation/surgery Arrhythmias,Cardiac Mitral Valve Rheumatic Fever Abstract Background: Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF). Objectives: To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates. Methods: Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models. Results: Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames. Conclusions: The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates.info:eu-repo/semantics/openAccessSociedade Brasileira de Cardiologia - SBCArquivos Brasileiros de Cardiologia v.109 n.1 20172017-07-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017000700014en10.5935/abc.20170082 |
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Gomes,Gustavo Gir Gali,Wagner Luis Sarabanda,Alvaro Valentim Lima Cunha,Claudio Ribeiro da Kessler,Iruena Moraes Atik,Fernando Antibas |
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Gomes,Gustavo Gir Gali,Wagner Luis Sarabanda,Alvaro Valentim Lima Cunha,Claudio Ribeiro da Kessler,Iruena Moraes Atik,Fernando Antibas Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
author_facet |
Gomes,Gustavo Gir Gali,Wagner Luis Sarabanda,Alvaro Valentim Lima Cunha,Claudio Ribeiro da Kessler,Iruena Moraes Atik,Fernando Antibas |
author_sort |
Gomes,Gustavo Gir |
title |
Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
title_short |
Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
title_full |
Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
title_fullStr |
Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
title_full_unstemmed |
Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease |
title_sort |
late results of cox maze iii procedure in patients with atrial fibrillation associated with structural heart disease |
description |
Abstract Background: Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF). Objectives: To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates. Methods: Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models. Results: Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames. Conclusions: The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates. |
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Sociedade Brasileira de Cardiologia - SBC |
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2017 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017000700014 |
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