Efficacy of cut-and-sew surgical ablation for atrial fibrillation in patients with giant left atria undergoing mitral valve surgery: A propensity-matched analysis.

OBJECTIVE: Surgical management for patients with long-standing persistent (LSP) AF and giant left atria (GLA) associated with mitral valve diseases remains a challenge. We aimed to assess the efficacy of the cut-and-sew Maze procedure(CSM) in this subgroup of patients, in terms of maintenance of sinus rhythm (SR), atrial function, and to identify the operative risks of this procedure.

METHODS: A total of 229 patients with LSP-AF underwent CSM at our institution from December 2013 to October 2017. Patients were divided into 2 groups based on LA diameter: NGLA group (<65mm, n=171), GLA group (≥65mm, n=58). Patients with GLA were propensity score matched to patients without GLA resulting in 45 pairs of patients.

RESULTS: Early death occurred in 1(2.2%) in GLA group and no deaths in NGLA group (P=0.315). Early complications did not differ significantly between the 2 groups. The GLA group showed similar rates of SR on and off antiarrhythmic drugs compared with NGLA group at 2 years (86.36% vs. 93.9%, P=0.338; 81.82% vs. 90.91%, P=0.322). At 2 years, LA contraction was comparable between patients with and without GLA (81.81%, vs. 90.9%, P=0.322). Right atrial contraction recovery rate was 96% in NGLA group, and 86.36% in GLA group (P=0.138).

CONCLUSIONS: Concomitant CSM is effective and feasible for restoration of SR and atrial contraction, for patients with LSP-AF and GLA associated with mitral valve diseases with acceptable operative risks.