[Evaluation of the results of the combined maze procedure for chronic atrial fibrillation with organic heart disease].

To examine the surgical indications and the results of the maze procedure, we reviewed 30 cases who underwent the maze procedure concomitantly with other open heart surgery from October 1995 to October 1997.: the average age was 60.9 years (37 to 75 years) and mean follow up period was 12.3 months (1 to 25 months). The modified maze procedure described by Kosakai and associates was applied in all patients. Twenty one patients (72.4%) regained atrial rhythm and eight patients (27.6%) sustained atrial fibrillation in the follow up periods. The left atrial diameter measured by echocardiography and cardiothoracic ratio were significantly larger in the latter group of patients, compared with those who recovered normal sinus rhythm (63.8 +/- 19.5 versus 51.2 +/- 7.8 mm and 67.7 +/- 8.1 versus 59.2 +/- 5.4%). In order to perform the combined maze procedure, cardiac arrest time and cardiopulmonary bypass time were extended for 56.9 minutes and 65.9 minutes, respectively, compared with the cases without a maze procedure. Four patients (brady atrial fibrillation 2, brady junctional rhythm 1, and complete AV block 1) required permanent pacemaker implantation. There was no operative death, but one patient who underwent the maze procedure and AVR + MAP + TAP died after 4 months due to pulmonary infection, sepsis and multiple organ dysfunction. This patient had shown low output syndrome for 3 days postoperatively. Having considered the data that the preoperative ejection fraction was 51%, cardiopulmonary bypass and cardiac arrest time were 200 min and 165 min respectively, occurrence of low cardiac output had been influenced by prolonged aortic cross-clamp. No late deaths have been observed in follow up period. In conclusion, maze procedure should not be performed in patients who have enlarged left atrium or complex cases requiring relatively longer operative time.