Background: The Cox Maze IV has emerged as an acceptable treatment modality for patients with atrial fibrillation undertaking concomitant open heart surgery. This study aimed to determine the factors associated with outcomes and recurrence of atrial fibrillation after Cox Maze IV procedure among patients with atrial fibrillation who underwent open heart surgery.
Methods: Patients who underwent Cox Maze IV from January 2016 to November 2017 were retrospectively analyzed and patients from December 2017 to November 2018 were prospectively analyzed. Pre operative, intraoperatiove and post operative factors and conversion to sinus rhythm were noted. Recurrence of AF was noted through 12 L ECG and or monitor at surgical ICU at immediately post op, post op day 1, day 7, 1 month and 1 year and 2D echo at 6 months.
Results: A total of 36 patients were analyzed. Pre operative, intra operative and post operative factors were not significantly associated. At last follow up, 16% (6/36) of patients converted to sinus rhythm and 31% (11/36) were free of atrial fibrillation. The mortality of Cox-Maze IV and cardiac surgery is high at 11% (4/36). The most common complications were prolonged ventilation, complete heart block, bleeding and stroke.
Conclusion: Result from the present data showed that the addition of Cox Maze IV procedure leads to conversion to sinus rhythm in open surgical patients in only few patients. These maybe due to selection bias and surgeon's learning curve. Patients that were analyzed retrospectively as compared to those who were seen prospectively has higher recurrence of atrial fibrillation. The high morbidity and mortality may be related to the long cardiopulmonary bypass and cross-clamp times and to the pre-operative co-morbidities. Further research should be directed to prospective study and towards follow-up of this patients up to 5 years.