Improved patient survival with concomitant Cox Maze III procedure compared with heart surgery alone.

Background: The benefit of the Cox Maze procedure combined with heart surgery was evaluated at long-term follow-up.

Methods: The outcome for 37 patients who underwent a Cox Maze III procedure combined with heart surgery (Maze group) was compared with that of 66 patients who had heart surgery alone (control group). All patients were in persistent atrial fibrillation preoperatively. The two groups had similar preoperative characteristics and were operated upon during the same era (1996 to 2004).

Results: Five-year survival, including hospital deaths, was 89% +/- 5% in the Maze group and 60% +/- 7% in the control group (log rank p = 0.008). Causes of death were predominantly related to heart failure (1 of 37 in the Maze group and 12 of 66 in the control group; p = 0.02) and to sudden death (0 of 37 in the Maze group and 9 of 66 in the control group; p = 0.02). After correction for preoperative variables, Cox regression analysis showed that the Maze procedure improved survival independently (p = 0.019). In a subgroup of patients with left atrial diameter of more than 60 mm preoperatively, the 5-year survival estimate was 92% +/- 6% in the Maze group versus 59% +/- 9% in the control group (log rank p = 0.012). The 5-year estimate of conversion to sinus rhythm was 91% +/- 7% in the Maze group and 33% +/- 7% in the control group (log rank p < 0.001).

Conclusions: The restoration of sinus rhythm by a Maze procedure combined with heart surgery markedly improved long-term survival in this series.