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A Journal on Heart and Vascular Diseases
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Minerva Cardioangiologica 2015 October;63(5):389-96
Concomitant MAZE procedure during cardiac surgical procedures: is there any survival advantage in conversion to sinus rhythm?
Neragi-Miandoab S., Skripochnik E., Michler R. E., Friedman P., D’Alessandro D. A.
Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
AIM: The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long-term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently.
METHODS: We retrospectively evaluated the conversion rate to SR and its correlation with long-term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2±12.0 years and 52.2% were female (N.=109). Perioperative mortality was 5.74% (N.=12).
RESULTS: In univariate analysis, significant risk factors for perioperative mortality were age (P=0.0033), duration of perfusion time (P=0.0093), elevated creatinine (≥1.6 mg/dL, P=.02), and cross clamp time (P=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five-year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five-year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (N.=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five-year survival rates for patients who were still in AF upon discharge (N.=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (P=0.24). Significant risk factors for long-term mortality included DM (P=0.023), preoperative MI (P=0.043), preoperative renal insufficiency (creatinine, ≥1.6 mg/dL, P=0.02) and asthma/COPD (P=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long-term mortality.
CONCLUSION: The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.