Minimally Invasive Cox-maze Iv Procedure Concomitant With Mitral Valve Repair Has Excellent Short- And Long-term Outcomes
Matthew R. Schill, Spencer J. Melby, Laurie A. Sinn, Richard B. Schuessler, Hersh S. Maniar, Ralph J. Damiano, Jr..
Washington University in St. Louis, Saint Louis, MO, USA.
OBJECTIVE: The Cox-Maze IV procedure (CMIV) performed via a minimally invasive right minithoracotomy (RMT) has been shown to be an effective treatment for atrial fibrillation (AF). This study examined short- and long-term outcomes with minimally invasive mitral valve repair (MIMVr) and concomitant CMIV at a single institution.
METHODS: Between 11/2003 and 5/2016, 65 consecutive patients underwent MIMVr and CMIV (biatrial 57/65,88%; left atrial [LA] 8/65,12%) via a RMT. Outcomes were evaluated using descriptive statistics. Freedom from atrial tachyarrhythmias (ATA) was ascertained using electrocardiography, Holter, loop recorder or pacemaker interrogation at 1-5 years. Prolonged monitoring was used in 47/65 patients (72%). Survival was ascertained from medical records. Data are expressed as median and interquartile range; freedom from ATA and antiarrhythmic drugs (AAD) are expressed with 95% confidence interval.
RESULTS: Forty-nine percent (32/65) of the patients were male, and median age was 67 years. Most (38/65,58%) had paroxysmal AF; the remainder had persistent (6/65,9%) or longstanding persistent (21/65,32%) AF. Twenty-one patients (32%) had functional mitral regurgitation (MR); 44 (68%) had degenerative MR. Median LA size was 4.7 cm [4.0,5.4]. Seven patients (11%) had a previous catheter ablation. Twenty-seven patients (42%) had Class III/IV heart failure. Median left ventricular ejection fraction was 0.60 [0.54,0.65]. Median cross-clamp time was 109 min [95,119]. There were no operative deaths or postoperative strokes. Major complications occurred in 9/65 patients (14%). Median ICU time was 49 hr [24,96]; median hospital length of stay was 7 days [6,9]. Five patients (8%) required a postoperative pacemaker. Follow-up, freedom from ATA and freedom from ATA and AAD were 85%, 98%, and 90% at one year and 80%, 88% and 81% at five years, respectively (Figure). At median 2.3-year follow-up, survival was 92% (36/39). Only 3/62 patients (5%) developed ≥2+ MR at 364 days postoperatively [96,1265].
CONCLUSIONS: MIMVr with CMIV is highly effective for AF and MR. This procedure is safe when performed at an experienced center.
LEGEND: Freedom from ATA and ATA/AAD after MIMVr/CMIV.
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