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Concomitant MAZE procedure during cardiac surgical procedures, is there any survival advantage in conversion to sinus rhythm?

Minerva Cardioangiol. 2014 Oct 30;

Authors: Neragi-Miandoab S, Skripochnik E, Michler RE, Friedman P, D’alessandro DA

Abstract
BACKGROUND: The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long–term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently.
METHODS AND RESULTS: We retrospectively evaluated the conversion rate to SR and its correlation with long–term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2 ± 12.0 years and 52.2% were female (n=109). Perioperative mortality was 5.74% (n=12). In univariate analysis, significant risk factors for perioperative mortality were age (p=0.0033), duration of perfusion time (p=0.0093), elevated creatinine (?1.6 mg/dL, p=.02), and cross clamp time (p=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five–year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five–year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (n=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five–year survival rates for patients who were still in AF upon discharge (n=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (p=0.24). Significant risk factors for long–term mortality included DM (p=0.023), preoperative MI (p=0.043), preoperative renal insufficiency (creatinine, ?1.6 mg/dL, p=0.02) and asthma/COPD (p=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long–term mortality.
CONCLUSION: The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.

PMID: 25358018 [PubMed – as supplied by publisher]

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