# Long-Term Outcomes of Concomitant Modified Cox-Maze and Mitral Surgery

## TL;DR

This study shows that combining Maze and mitral valve surgery effectively manages atrial fibrillation and mitral disease, with long-term benefits and predictors of success identified.

## Contribution

The study provides long-term outcomes (up to 15 years) of combined Maze and mitral surgery, which is novel due to limited prior data beyond 10 years.

## Key findings

- Freedom from atrial fibrillation at 5, 10, and 15 years was 82.5%, 70.8%, and 52.7%, respectively.
- Patients in sinus rhythm had fewer neurological complications compared to those in atrial fibrillation.
- Predictors of AF recurrence included preoperative AF duration, left atrial diameter >50 mm, and postoperative AF on day 7.

## Abstract

Purpose: There are limited data on outcomes of combined Maze and mitral valve procedures beyond 10 years. This study analyzed the efficacy of this operation.

Methods: Between June 2004 and December 2022, 406 patients underwent mitral surgery concomitant with Maze procedure were evaluated. Rhythm outcomes, predictors of recurrence, and survival were assessed.

Results: The median follow-up period was 100 months. Rheumatic disease was present in 58%. Mitral valve repair was performed in 57.1%. Freedom from atrial fibrillation (AF) at 5, 10, and 15 years was 82.5%, 70.8%, and 52.7%, respectively. Overall survival rates were not different between patients in sinus rhythm (SR) and those who remained in AF (p = 0.172). However, patients in SR experienced fewer neurological complication (p = 0.001). Predictors of AF recurrence included preoperative AF duration (p = 0.005), left atrial diameter (LAD) >50 mm (p <0.001), concomitant tricuspid valve surgery (p = 0.049), and the presence of AF on postoperative day 7 (p <0.001). Factors influencing survival were age >60 years (p <0.001) and a postoperative left ventricular ejection fraction <40% (p <0.001).

Conclusions: The combined Maze and mitral valve surgery provides significant benefits in managing AF with mitral disease. Predictors of recurrence included AF duration, LAD size >50 mm, associated tricuspid valve disease, and AF on day 7. SR patients had fewer neurological complications.