Background: There was limited evidence on the clinical benefits of the concomitant Cox-Maze procedure with aortic valve replacement (AVR) in patients with atrial fibrillation. This study aimed to evaluate the early and long-term results of the concomitant Cox-Maze procedure in patients undergoing AVR for aortic valve disease.
Methods: We enrolled 101 patients who underwent AVR and had preoperative atrial fibrillation between January 1994 and December 2020. The early- and long-term clinical outcomes were compared between patients who underwent the concomitant Cox-Maze III procedures and those who did not undergo surgical ablation. Inverse probability of treatment weighting (IPTW) was used to adjust for differences in preoperative characteristics.
Results: Forty-seven patients underwent the concomitant Cox-Maze III procedure (CM group), and 54 patients did not undergo surgical ablation for atrial fibrillation (non-CM group). There were no significant differences in early surgical outcomes between the two groups, except for a higher occurrence of acute kidney injury (AKI) in the CM group (P<0.001). The median follow-up duration was 70.7 months (interquartile range 36.2–118.8 months), and there were no significant differences in overall survival, thromboembolic complications, and anticoagulation-related bleeding between the two groups. Atrial fibrillation occurrence was significantly lower (P<0.001) in the CM group, and a greater number of patients discontinued anticoagulation in the CM group compared to the non-CM group (P=0.001).
Conclusions: The concomitant Cox-Maze procedure in patients with atrial fibrillation undergoing AVR did not increase early mortality or morbidity, except for AKI, and showed favorable long-term results in terms of rhythm outcome and anticoagulation discontinuation.
Keywords: Aortic valve replacement (AVR); Cox-Maze procedure; atrial fibrillation
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Key findings
• The concomitant Cox-Maze procedure with aortic valve replacement (AVR) in patients with atrial fibrillation showed favorable long-term results in terms of rhythm outcome and anticoagulant discontinuation.
What is known and what is new?
• There was limited evidence on the clinical benefits of the concomitant Cox-Maze procedure with AVR in patients with atrial fibrillation.
• The concomitant Cox-Maze procedure with AVR in patients with atrial fibrillation does not increase early mortality and morbidity except for acute kidney injury and showed lower occurrence rates of atrial fibrillation and higher rates of anticoagulant discontinuation.
What is the implication, and what should change now?
• In patients undergoing AVR for aortic valve diseases, the concomitant Cox-Maze procedure should be actively considered if atrial fibrillation is accompanied.
Cite this article as: Kim CH, Kang Y, Kim JS, Lee Y, Kim SH, Sohn SH, Hwang HY, Kim KH, Choi JW. Long-term outcomes of concomitant Cox-Maze III procedure in patients with aortic valve diseases and preoperative atrial fibrillation. J Thorac Dis 2025;17(1):369-378. doi: 10.21037/jtd-24-1223
