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 .
Combined radiofrequency modified maze and mitral valve procedure through a port access approach: early and mid-term results.
OBJECTIVE The aim of this study was to assess the feasibility and effectiveness of irrigated radiofrequency ( RF ) modified Maze procedure through a port access approach during mitral valve surgery and evaluate early and mid-term results . MATERIAL AND METHOD During a 16 months time period , 67 patients with chronic atrial fibrillation ( AF ) eligible for port access mitral valve surgery  were r and omly assigned to either Group A , in which they underwent a combined procedure ( N = 33 ) or Group B , in which a valve procedure alone was performed ( N = 34 ) . Both groups were similar in terms of age , sex , valve pathology , duration of AF left atrial diameter and left ventricle function ( P > 0.05 ) . Four had undergone previous operations . RESULTS Median follow-up was 10 months for both groups , 95 % CI ( 9.18 - 10.8 ) . One patient in each group died early postoperatively ( 3 and 2.9 % ) . Two patients required reoperation for bleeding , one in each group ( 3 and 2.9 % ) . There were two conversions to right thoracotomy . In Group A , freedom from AF was 100 % at the end of the operation ( 76 % sinus , 24 % pacemaker ) Six and twelve months freedom from AF was 87.2 and 93.6 % , respectively . In Group B , freedom from AF at the end of operation was 41 % . At the end of 6 and 12 months , freedom from AF was 9.4 % ( P = 0.0001 ) . One patient in Group A required a permanent pacemaker ( 3 % ) . During follow-up , one patient in Group A died of non-cardiac causes ( 3 % ) . In Group B , there were two late deaths : one cardiac ( 2.9 % ) and one neurologic ( 2.9 % ) . There were no thromboembolic events detected in Group A during follow-up , whereas two patients in Group B suffered this complication ( 6 % , P = 0.081 ) . At 12 months , functional capacity had improved for patients in both groups ( P < 0.0001 ) . CONCLUSION The combination of mitral valve surgery and irrigated RF Maze procedure was safe and efficient through a port access approach . There were no procedure related complications like esophageal or coronary artery injury . Early and mid-term results were favourable with 93.6 % of patients free of AF at 1 year in comparison to the 9.4 % of the control group . The data is not sufficient to reach any conclusions in terms of thromboembolic rates , despite favourable results for the RF Maze group . Nevertheless , in terms of feasibilty , sinus rhythm restoration and overall outcome , early results are encouraging and we advocate the use of the combined procedure through a port access approach
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 .