Objectives: The benefit of the 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 (standard or by radiofrequency ablation) combined with heart surgery (maze group) was compared with that of 66 patients who had heart surgery alone (control group). All patients were in permanent atrial fibrillation preoperatively. The two groups had similar preoperative characteristics and were operated on during the same era (1996 to 2004). The left atrial diameter averaged 70 ± 12 mm.
Results: Five-year survival, including hospital deaths, was 89 ± 5 % in the maze group and 60 ± 7 % in the control group (log-rank p < 0.01). Causes of death were predominantly related to heart failure (1/37 in the maze group and 12/66 in the control group; p = 0.02) and to sudden death (0/37 in the maze group and 9/66 in the control group; p = 0.02). After correction for preoperative variables, Cox regression analysis showed that the maze procedure improved survival independently (p = 0.02). In a subgroup of patients with left atrial diameter over 60 mm preoperatively, the five-year survival estimate was 92 ± 6% in the maze group versus 59 ± 9% in the control group (log-rank p = 0.01).
Conclusions: The restoration of sinus rhythm by a maze procedure combined with heart surgery markedly improved long-term survival in this series.