Mid-Term Results of the Cox Maze III Procedure Combined With Open Mitral Commissurotomy for the Treatment of Rheumatic Mitral Stenosis

Abstract

The purpose of the present study was to evaluate the mid-term results of the Cox maze III procedure (CM-III) combined with open mitral commissurotomy (OMC) for the treatment of rheumatic mitral stenosis (MS) associated with persistent atrial fibrillation (AF). Cardiac rhythm was determined before and after surgery in 50 patients with MS presenting with AF who underwent OMC with modified CM-III using cryoablation between May 2001 and April 2009. At late follow up among 50 patients, 45 patients (90%) maintained sinus rhythm (SR) for 6-97 months after surgery. The maintenance rates of SR were 91.7%, 89.2%, and 89.2% at 1, 3, and 5 years after surgery, respectively. Preoperative left atrial dimension (P=0.016) and AF or junctional rhythm at discharge (P<0.001) were found to significantly influence the maintenance of SR after CM-III. Late follow-up echocardiography performed after a mean interval of 28.7 months (range, 1-85 months) showed mitral valve areas ranging from 1.20 to 2.60 cm and pressure gradients across the mitral valve ranging from 1.80 to 7.0 mmHg. There were 2 late deaths, but no early death, and no reoperation was required during the follow-up period. The addition of CM-III to OMC was safe and effective for selected patients. A preoperative large left atrial size was found to be significantly associated with AF treatment failure.