Improved Patient Survival With Concomitant Cox Maze III Procedure Compared With Heart Surgery Alone

Louagie, Yves; Buche, Michel; Eucher, Philippe; Schoevaerdts, Jean-Claude; Gerard, Marina; Jamart, Jacques; Blommaert, Dominique

doi:10.1016/j.athoracsur.2008.10.001

Cited by 50 publications

(25 citation statements)

References 34 publications

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“…More significant ablation effects, relative to mortality and morbidity, are expected in the long term 31 ; therefore, a 5-year follow-up is planned. Analysis of left atrial cryo-ablation failure risk factors found age, size of the LA, and pre-operative duration of AF to be risk factors of failure-to-restore SR in the whole set of patients; this was in accordance with other publications.…”

Section: Discussionmentioning

confidence: 99%

Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study

Budera

Straka

Osmančík

et al. 2012

European Heart Journal

114

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AimsSurgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes.Methods and resultsThis multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n = 117) vs. group B (no ablation, n = 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2% of group A patients vs. 35.5% in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3% (group A) vs. 14.7% (group B, P = 0.411). All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P = 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9%, P < 0.001).ConclusionSurgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later.

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Section: Discussionmentioning

confidence: 99%

Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study

Budera

Straka

Osmančík

et al. 2012

European Heart Journal

114

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“…1335 A longitudinal study (up to 120 months) demonstrated that restoration of sinus rhythm by a Cox-Maze procedure combined with heart surgery markedly increased long-term survival. 1336 …”

Section: Section 12: Surgical and Hybrid Af Ablationmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,742

1,448

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“…131 AF patients requiring other cardiac surgery may benefit from the addition of a maze procedure. 132 Data in patients with reduced LV function are limited. Stulak et al retrospectively analyzed 37 patients with a reduced LV function (mean LVEF, 44%), who underwent a maze procedure for paroxysmal and chronic AF and flutter between 1993 and 2002.…”

Section: Surgical Ablation Of Atrial Fibrillationmentioning

confidence: 99%

Atrial Fibrillation in Congestive Heart Failure

Seiler

Stevenson

2010

Cardiology in Review

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Atrial fibrillation (AF) and heart failure (HF) are common and interrelated conditions, each promoting the other, and both associated with increased mortality. HF leads to structural and electrical atrial remodeling, thus creating the basis for the development and perpetuation of AF; and AF may lead to hemodynamic deterioration and the development of tachycardia-mediated cardiomyopathy. Stroke prevention by antithrombotic therapy is crucial in patients with AF and HF. Of the 2 principal therapeutic strategies to treat AF, rate control and rhythm control, neither has been shown to be superior to the other in terms of survival, despite better survival in patients with sinus rhythm compared with those in AF. Antiarrhythmic drug toxicity and poor efficacy are concerns. Catheter ablation of AF can establish sinus rhythm without the risks of antiarrhythmic drug therapy, but has important procedural risks, and data from randomized trials showing a survival benefit of this treatment strategy are still lacking. In intractable cases, ablation of the atrioventricular junction and placement of a permanent pacemaker is a treatment alternative; and biventricular pacing may prevent or reduce the negative consequences of chronic right ventricular pacing.

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Improved Patient Survival With Concomitant Cox Maze III Procedure Compared With Heart Surgery Alone

Cited by 50 publications

References 34 publications

Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study

Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Atrial Fibrillation in Congestive Heart Failure

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