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In-hospital And Long Term Outcomes Of Simultaneous Cox Maze V Procedure In Patients With Concomitant Af Who Undergo Cabg
Vadim Popov, MD, Amiran Revishvili, Egor Malyshenko, Maxim Anishchenko, Natalia Popova, Natalia Ardashova;
A.V. Vishnevsky National Medical Research Centre of Surgery, Moscow, Russian Federation
BACKGROUND:To establish an optimal surgical treatment for concomitant atrial fibrillation (AF) during CABG is vital in cardiovascular surgery. We use simultaneous Cox Maze V procedure for AF treatment in patients who undergo CABG in our center
METHODS: A prospective single-center trial included 105 patients with CAD and AF. Patients were randomized into 2 groups - patients with paroxysmal AF (group I, n=53) and non-paroxysmal AF (group II, n=52). Patients underwent on-pump CABG with additional Cox Maze V procedure. The Cox Maze V procedure was performed without aortic cross-clamping using parallel perfusion before CABG. Primary endpoints included arrhythmia recurrence, sinus rhythm, MACCE and secondary endpoints included CPR, cross-clamping aorta, surgery, ventilation time and time of ICU stay, pacemaker implantation
RESULTS:There were no differences in the types and frequency of complications. During hospitalization, 2 (3.8%) deaths were documented in group II due to multiple organ failure. There were no cases of MACCE in both groups. The combination of AF/AFl was more often observed in group II - 15 (28.8%) versus 7 (13.3%), p=0.05. The rate of AF recurrence was significantly higher in group II - 14 (26.9%) versus 6 (11.3%), p=0.049. By the end of hospitalization, sinus rhythm had 100% and 90.4% patients in groups I and II, respectively (p=0.02). There were no significant differences in secondary endpoints. The cumulative freedom from AF/AFL was 100% and 97% in groups I and II in 1 year of follow up; 96.1% and 91.4% in 2 years of follow up; 90.9% and 78.7% in 3 years of follow up (Logrank Test, p=0.07). Cumulative freedom from MACE was 90.2 and 100% in 3 years of follow-up (Logrank Test, p=0.23). Permanent pacemaker implantation wasn’t required either in short or long-term follow-up
CONCLUSIONS: The Cox Maze V procedure for concomitant AF did not didn’t significantly affect the follow up period, which may reflect its sufficient safety. The results of concomitant Cox Maze V procedure allow us to recommend this strategy for simultaneous AF treatment in CABG.
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