Operative results after the Cox/maze procedure combined with a mitral valve operation

Background. There have been few reports on postoperative morbidity and mortality analyses after concomitant mitral valve operation and the Cox/maze procedure. Methods. Between April 1993 and August 1995, 87 consecutive patients with chronic atrial fibrillation underwent a mitral valve operation and concomitant Cox/maze procedure at Iwate Medical University. The patients were divided into the replacement group (n = 31) and repair group (n = 56) according to the method of mitral valve replacement. Our initial experience with the combined operative procedures is presented along with the operative mortality and morbidity rates. Univariate analysis on preoperative and intraoperative variables affecting early mortality and morbidity is carried out retrospectively. Results. Total cardiopulmonary bypass time in all patients was 177.2 ± 70.1 minutes. Total aortic cross-clamp time was 121.7 ± 30.8 minutes. Total intensive care unit stay was 5.3 ± 7.9 days. The average intubation period was 55.5 ± 187.6 hours. The intensive care unit stay and the intubation period of the replacement group were longer than those of the repair group. There were four operative deaths among the 87 patients (4.6%). All repair group patients survived operation, whereas 4 replacement group patients died after operation. In all patients, the New York Heart Association functional class was higher ( p = 0.028) in those who died than in those who survived. The overall restoration rate from atrial fibrillation was 79.5% (66 of 83 survivors). Seventeen patients (20.5%) had persistent atrial fibrillation postoperatively. Sick sinus syndrome occurred in 7 patients (8.4%). In the repair group, the restoration rate was 76.8%, whereas in the replacement group it was 85.2% for the survivors. Conclusions. The Cox/maze procedure can be combined with a mitral valve operation with acceptably low operative risk. Analysis of risk factors of early mortality revealed that the type of mitral valve operation (replacement versus repair) and higher preoperative New York Heart Association functional class were associated with mortality. Long-term results from this combined procedure should be clearly demonstrated before its universal acceptance.