RISKS AND BENEFITS OF COMBINED MAZE PROCEDURE FOR ATRIAL-FIBRILLATIONASSOCIATED WITH ORGANIC HEART-DISEASE

Objectives. This study sought to identify the risks and benefits of ad ding the maze procedure in patients with atrial fibrillation (AF) unde rgoing operation for underlying organic cardiac disorders. Background. Persistent AF often leaves patients symptomatic even after otherwise successful cardiac surgery. Methods, Fifty-one patients undergoing val vular operation and the maze procedure (n = 43) or repair of congenita l anomalies (n = 8) combined with the maze procedure were compared wit h 51 patients (control group) matched for underlying diseases and proc edures except for the maze operation, Each group, including 31 patient s with a concomitant tricuspid annuloplasty and 12 undergoing reoperat ion, were similar in age, duration of arrhythmia, degree of cardiomega ly and New York Heart Association functional class. Results. Patients undergoing the maze procedure had longer cardiopulmonary bypass time ( 213 vs. 144 min, p < 0.0001), longer cardiac arrest (134 vs, 93 min, p < 0.0001) and greater blood loss with longer respiratory care (39 vs, 18 h,p = 0.021) and intensive care unit stay but no mortality. No sig nificant differences were found in catecholamine or transfusion requir ements immediately after operation, Sustained AF was much less frequen t in the maze group (12% at 1 year) than the control group (86%, p < 0 .0001), with an average follow-up period of 32 months (range 25 to 42) , Atrial contraction was documented in 41 (80%) and 40 (78%) patients for right and left ventricular filling, respectively, after the maze p rocedure, resulting in a significantly smaller cardiac size and improv ed functional capacity, Medication was discontinued in seven patients in the maze group compared with two in the control group. Conclusions. Improved restoration of atrial rhythm and contraction with combined m aze operation appeared to justify the increased operative time and com plexity and postoperative care.