Is Maze V the optimal procedure for treating concomitant  AF in CABG?

 

Amiran Sh. Revishvili, Vadim A. Popov, Egor S. Malyshenko, Maksim M. Anishchenko, Kirill A. Kozyrin, Natalia V. Popova

A.V. Vishnevsky National Medical Research  Center of Surgery, Moscow, Russia

Objective: Concomitant atrial fibrillation during CABG  is present in 5-20% of cases. The issues  of choosing the optimal procedure for the simultaneous treatment of AF during CABG remains. In this regard, the Maze V procedure without opening the heart cavities has obvious advantages

Methods: A retrospective study of the results was conducted in 105 patients after the concomitant Maze V procedure during CABG in two groups of patients. those with paroxysmal AF (group I, n=53) and those with non-paroxysmal AF(group II, n=52). and non-paroxysmal AF All underwent conventional on-pump CABG. The Maze V procedure was performed as an on-pump beating heart procedure without cross-clamping of the aorta before CABG. The primary endpoints included the  freedom of AF/AFL/AT/PT recurrence and the MACCE. The secondary endpoints among others included permanent pacemaker implantation.
Results: MACCE was not observed in both patient groups and no patients required a permanent pacemaker at in-hospital period.  At discharge, cumulative freedom from AF/AFL/AT/PT was present in 100% of Group I and 90.4% Group II  (p=0.02). The cumulative freedom from AF/AFL/AT/PT at 1. 2 and 3 years  was 100% /97% ,  96.1% / 91.4%  , 90.9% / 78.7% respectively ( p=0.07). Freedom from MACCE at 3 years was 90.2% and 100%   (p=0.23).
Conclusions: The outcomes of the Maze V procedure in this trial allow us to recommend this strategy for simultaneous treatment paroxysmal and non-paroxysmal AF in patients  undergoing CABG.