Cox-maze IV cryoablation and postoperative heart failure in mitral valve surgery patients. SCAND CARDIOVASC J 2016;51:15-20. [PMID: 27248647 DOI: 10.1080/14017431.2016.1196827]

Safety and efficacy of Cox-Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

BACKGROUND

Cox-Maze procedure is currently the gold standard treatment for atrial fibrillation (AF). However, data on the effectiveness of the Cox-Maze procedure after concomitant mitral valve surgery (MVS) are not well established. The aim of this study was to assess the safety and efficacy of Cox-Maze procedure versus no-maze procedure n in AF patients undergoing mitral valve surgery through a systematic review of the literature and meta-analysis.

METHODS

A systematic search on PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 02, 2017) databases were performed using three databases from their inception to March 2023, identifying all relevant randomized controlled trials (RCTs) comparing Cox-Maze procedure versus no procedure in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints.

RESULTS

Nine RCTs meeting the inclusion criteria were included in this systematic review with 663 patients in total (341 concomitant Cox-Maze with MVS and 322 MVS alone). Across all studies with included AF patients undergoing MV surgery, the concomitant Cox-Maze procedure was associated with significantly higher sinus rhythm rate at discharge, 6 months, and 12 months follow-up when compared with the no-Maze group. Results indicated that there was no significant difference between the Cox-Maze and no-Maze groups in terms of 1 year all-cause mortality, pacemaker implantation, stroke, and thromboembolism.

CONCLUSIONS

Our systematic review suggested that RCTs have demonstrated the addition of the Cox-Maze procedure for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke, and thromboembolism.

[Predictors of atrial fibrillation recurrence after biatrial cryo-maze procedure: a systematic review]

Today, the issue of atrial fibrillation recurrence after ablation is increasingly discussed in the literature. Many authors analyze the factors predicting success or failure of cryo-maze procedure. This review is devoted to predictors of atrial fibrillation recurrence in long-term period after biatrial cryo-maze procedure. Primary screening identified 48 studies. There were 27 articles after removing duplicate articles, case reports and articles with unavailable full-text versions. Two independent researchers reviewed the full-text articles and enrolled 11 and 14 articles, respectively. After collegial discussion and involving the third researcher, we selected 13 articles for final analysis. It was established that atrial enlargement and duration of atrial fibrillation are the main independent predictors of recurrence in long-term period.