MODIFIED MAZE PROCEDURE FOR PATIENTS WITH ATRIAL-FIBRILLATION UNDERGOING SIMULTANEOUS OPEN-HEART-SURGERY

Persistent atrial fibrillation (AF) leaves patients symptomatic and at increased risk of thromboembolism even after otherwise successful car diac surgery. Methods and Results To treat AF secondary to cardiac les ions requiring surgery, we combined a modified maze procedure in 101 p atients simultaneously undergoing valvular procedures (87), repair of congenital anomalies (12), and other procedures (2), including 24 repe at operations. Duration of AF varied from 0.1 to 30 years (average+/-S D, 8.8+/-7.0 years); the f-wave voltage ranged from 0 to 0.45 mV (0.15 +/-0.09 mV); and cardiothoracic ratio varied from 40% to 99% (63+/-9%) . Aortic cross-clamp time varied from 75 to 229 minutes (138+/-31 minu tes), with bypass time ranging from 119 to 326 minutes (217+/-42 minut es). There were two early deaths (2%), no late deaths, and one episode of transient neurological ischemic attack in follow-up ranging from 1 .0 to 3.1 years, for a total of 190 patient-years. Postoperative rhyth ms were sinus in 83 patients (82%), junctional in 4 (4%), and persiste nt AF in 14 (14%), each of whom had mitral valve disease. Patients wit h other underlying pathology had complete recovery of atrial rhythm. A normal-sized A wave was detected in 88% for transtricuspid flow and i n 73% for transmitral flow, suggesting concomitant recovery of atrial contraction. Among 36 patients without mechanical valves, 30 (83%) wit h atrial rhythm and contraction have been taken off anticoagulation th erapy, including 10 who are free of all medication. Conclusions. The r esults suggest that the combined approach is safe, effective, and indi cated in patients who are judged capable of tolerating the procedure a nd likely to regain atrial rhythm.