Results The consensus panel agreed on the following statements in patients with AF undergoing cardiac surgery concomitant surgical ablation : 1 .
Improves the achievement of sinus rhythm at discharge and 1 year ( level A ) ; this effect is sustained up to 5 years ( level B ) .
2 .
3 .
Does not increase the risk of perioperative mortality ( level A ) , stroke ( level A ) , myocardial infa rct ion ( level B ) , cardiac tamponade ( level A ) , reoperative bleeding ( level A ) , esophageal injury ( level B ) , low cardiac output ( level A ) , intraaortic balloon ( level B ) , congestive heart failure ( level B ) , ejection fraction ( EF ; level B ) , pleural effusion ( level A ) , pneumonia ( level A ) , renal dysfunction ( level B ) , and mediastinitis ( level A ) .
The incidence of esophageal injury remains to be low ( level B ) .
4 .
Does not reduce mortality at 1 year ( level A ) .
5 .
6 .
Increases cardiopulmonary bypass and cross-clamp times ( level A ) , with no difference in intensive care unit and hospital length of stay ( level A ) .
Conclusions Given these evidence -based statements , the consensus panel stated that , in patients with persistent and permanent AF undergoing cardiac surgery , concomitant surgical ablation is recommended to increase incidence of sinus rhythm at short- and long-term follow-up ( class 1 , level A ) ; to reduce the risk of stroke and thromboembolic events ( class 2a , level B ) ; to improve EF ( class 2a , level A ) ; and to exercise tolerance ( class 2a , level A ) and long-term survival ( class 2a , level B )
Objective This purpose of this consensus conference was to determine whether surgical atrial fibrillation ( AF ) ablation during cardiac surgery improves clinical and re source outcomes compared with cardiac surgery alone in adults undergoing cardiac surgery for valve or coronary artery bypass grafting .
Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease.
BACKGROUND The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease . Recently , ectopic foci , originating in the pulmonary veins , were demonstrated in patients with atrial fibrillation , and the indication was that their arrhythmia could have a focal origin . In the light of this new evidence , a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery . This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery . METHODS A prospect i ve clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were r and omized in accordance with the type of surgery used on each : ( 1 ) . associated en bloc isolation of pulmonary veins , ( 2 ) . the Maze procedure , or ( 3 ) . mitral valve correction alone . The preoperative clinical characteristics were similar in the three groups . RESULTS The overall postoperative complications were similar in all three groups . The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group , but this factor bore no relation to increased morbidity in the intervention groups . The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins ( p = 0.010 ; 95 % confidence interval , 0.01 to 0.71 ) and 0.20 in the Maze group ( p = 0.044 ; 95 % confidence interval , 0.04 to 1.02 ) compared with the control group . CONCLUSIONS En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation
Results The consensus panel agreed on the following statements in patients with AF undergoing cardiac surgery concomitant surgical ablation : 1 .
Improves the achievement of sinus rhythm at discharge and 1 year ( level A ) ; this effect is sustained up to 5 years ( level B ) .
2 .
3 .
Does not increase the risk of perioperative mortality ( level A ) , stroke ( level A ) , myocardial infa rct ion ( level B ) , cardiac tamponade ( level A ) , reoperative bleeding ( level A ) , esophageal injury ( level B ) , low cardiac output ( level A ) , intraaortic balloon ( level B ) , congestive heart failure ( level B ) , ejection fraction ( EF ; level B ) , pleural effusion ( level A ) , pneumonia ( level A ) , renal dysfunction ( level B ) , and mediastinitis ( level A ) .
The incidence of esophageal injury remains to be low ( level B ) .
4 .
Does not reduce mortality at 1 year ( level A ) .
5 .
6 .
Increases cardiopulmonary bypass and cross-clamp times ( level A ) , with no difference in intensive care unit and hospital length of stay ( level A ) .
Conclusions Given these evidence -based statements , the consensus panel stated that , in patients with persistent and permanent AF undergoing cardiac surgery , concomitant surgical ablation is recommended to increase incidence of sinus rhythm at short- and long-term follow-up ( class 1 , level A ) ; to reduce the risk of stroke and thromboembolic events ( class 2a , level B ) ; to improve EF ( class 2a , level A ) ; and to exercise tolerance ( class 2a , level A ) and long-term survival ( class 2a , level B )
Objective This purpose of this consensus conference was to determine whether surgical atrial fibrillation ( AF ) ablation during cardiac surgery improves clinical and re source outcomes compared with cardiac surgery alone in adults undergoing cardiac surgery for valve or coronary artery bypass grafting .