RHEUMATIC VALVULAR HEART SURGERY AND MAZE III PROCEDURE

Objectives- Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Drug treatment of AF usually leads to an unsatisfactory rate of recurrence. The Cox-maze III procedure for atrial fibrillation has been effective in restoring sinus rhythm in patients with mitral valve disease.
Methods- From September 2000 to September 2002, 10 consecutive patients with rheumatic mitral valve disease and chronic AF underwent the Cox-maze III procedure concomitantly with mitral valve replacement. Associated procedures were tricuspid valve repair in 4 patients and aortic valve replacement in 2 patients. Our indications to perform the Maze-III procedure were chronic AF, medical history of previous thromboembolic events and large left atrium on preoperative transthoracic echocardiography.
Results- There were 2 men and 8 women with a mean age of 40±8 years. Mean aortic cross-clamp and cardiopulmonary, bypasstimes were 90±11 and 144±18 minutes, respectively. There was no in-hospital mortality. Normal sinus rhythm was restored early postoperatively in 60% and late in 80% of the patients. Right atrial and left atrial contractility was found in 80% and 70% of the patients in transesophageal echocardiography 6 months postoperatively.
Conclusions- The maze III procedure associated with mitral valve replacement is a safe and effective surgical technique for conversing A'F to sinus rhythm and restoring atrial contractility in rheumatic heart disease.