Maze surgery for the treatment of atrial fibrillation in patients with valvular pathology: Is it safe and improves survival?

Abstract

Maze surgery was developed for the treatment of atrial fibrillation. However safety and effectiveness has been questioned. Objectives: To analyze the perioperative morbidity and mortality of Maze surgery and its effectiveness and impact on survival in the follow-up. Materials and methods: Were included consecutively between January 2004 and December 2013 all patients undergoing cardiac surgery (n = 4918) of which 383 (7.7%) had atrial fibrillation in context of valvular pathology constituting the study population. A comparative analysis of patients undergoing surgery Maze for treatment of atrial fibrillation (Maze group; n = 120,  31%) was conducted or absence Maze procedure (Group not Maze, n = 263, 69%) in the all patients (n = 383) and adjusted risk propensity score groups. Results: Maze group patients were younger (66.5 ± 10.5 vs. 69.5 ± 11.5 years, p ≤0.022) less hypertension (70% vs. 58.3%, p ≤0.026), had a higher rate of anticoagulation (34.2% vs 23.2%, p ≤0.024), had a lower Euroscore high risk (35% vs 58.2%, p ≤0.0001) and were more elective surgeries (80.8% vs 65%, p ≤0.002). The Maze procedure was performed in the left atrium (Left Maze, n = 35 patients, 29%) or both atria (Biatrial Maze, n = 85 patients, 71%). Hospital mortality (4.5% vs 6.1 Maze Surgery no surgery Maze%, p = 0.698), and perioperative complications were similar in both matched groups by risk score. Freedom of atrial fibrillation at follow-up was 72.7% at 2 years and 62.6% at 4 years. Overall survival was higher for the group of patients who underwent Maze surgery (77.9±4.6% vs 56.9±5.1%, log rank p = 0.046). After adjusting for risk score this difference in mortality follow-up did not reach statistical significance (86.5±4.5% Maze surgery vs 67.6±9.2% no Maze surgery, p = 0.351 log rank).
Conclusions: Maze surgery for the treatment of atrial fibrillation is a safe procedure that does not increase perioperative morbidity and mortality, provides a high rate of return of sinus rhythm and provides an advantage in the long-term survival.