["Cox/Maze-III operation" as surgical therapy of chronic atrial fibrillation during mitral valve and atrial septal defect II operation].

PROBLEM

Atrial fibrillation is associated with significant morbidity and mortality. The increased risk of thromboembolism makes constant anti-coagulation necessary, while the absence of atrial contraction worsens the hemodynamic situation. In this study we examined the results of simultaneous surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" while mitral valve surgery and atrial septal closure.

PATIENTS AND METHODS

Between February 1995 and July 1997 sixteen patients aged 50 to 72 y (mean: 59 y) underwent open heart surgery (mitral valve replacement n = 10, reconstruction n = 3; mitral valve reconstruction and atrial septal closure n = 1, atrial septal closure n = 1, thrombectomy from left atrium n = 1) and "Cox/Maze-III-procedure" in one session. Preoperative duration of chronic atrial fibrillation was between 2 and 12 y (mean: 5.0 y). The patients were examined preoperatively and postoperatively 3, 6, 12, and 24 months after surgery using the following methods: transesophageal echocardiography (TEE), ECG, long-term ECG, and stress ergometry.

RESULTS

During the early postoperative period (< 7 d) all of the patients were in sinus rhythm or atrial pacing; eight patients intermittently had atrial fibrillation. In the follow-up period from 1 to 27 months (mean 14 months), 15 patients have a stable sinus rhythm (94%). One patient, preoperatively known to have intermittent tachybradycardia, received a pacemaker 2 months postoperatively for sinus bradycardia. Postoperatively in TEE patients showed left atrial contraction with improvement of hemodynamic situation. Stress ergometry 6 months postoperatively showed lower increasements of heart rate, at 12 months normal frequency.

CONCLUSION

The surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" can be performed combined with other heart operations without increased perioperative or postoperative risks. The Maze-procedure is an effective surgical therapy of chronic atrial fibrillation. Postoperatively there is an improvement of the hemodynamic situation because of sinus rhythm and synchrone atrioventricular contraction.