The "Maze" procedure for surgical treatment of chronic atrial fibrillation (AF) described by Cox was performed in 34 patients (pts) from July 91 to October 94; 26 were female and the ages ranged from 35 to 68y (50.2y). All pts had mitral valve disease (MVD) and chronic AF (> 1 year). Thirty one pts had surgical rheumatic MVD (mitral stenosis in 21; mitral double disfunction in 9) and 3 had mixomatous MVD with severe regurgitation. Twenty eight pts were in FC (NYHA) IV and 6 in FC III preoperatively. Left atrium diameter varied from 4.4 to 6.5 cm (5.5 cm). In 21 pts the surgical treatment was performed following the original "Maze" technique and in 13 pts with the modifications proposed by Cox. The surgery was completed with 17 mitral conservative procedures and 17 mitral valve replacements (bovine pericardium bioprostheses). Eight pts had left atrial thrombosis. There were 2 (5.8%) immediate deaths (low cardiac output and severe liver disfunction) and 1 patient died in the 48th day with infeccious complications. The first patient required reoperation for bleeding review. Atrial arrhythmias were observed in 6 pts and 14 required temporary pace-maker. Regular "sinus" rhythm was observed in all pts. No other major complications were observed. In 30 pts with more than 6 months of follow up, 27 (90%) were in regular rhythm (heart rate from 55 to 87bpm), with no antiarrhythmic drugs and atrial contraction demonstrated by ECHO. In conclusion, the "Maze" procedure showed effective to treat AF even in pts with big atrium and MVD, with acceptable immediate and late results. Longer observation is required to a definitive conclusion.
Cox operation; Atrial fibrillation