Valvular atrial fibrillation outcomes associated with the cox-maze procedure at Charlotte Maxeke Johannesburg academic hospital from 2000 to 2015

Kukulela, Nangamso
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Objectives: Outcomes data on the efficacy of the Cox-maze procedure for the treatment of valvular atrial fibrillation mostly originates from developed countries, with a paucity of data from the developing world. The primary objective of this study was to determine the outcomes of the Cox-maze procedure for valvular atrial fibrillation (AF) in a public tertiary academic centre in Johannesburg, South Africa. Methods: We retrospectively reviewed inpatient and outpatient records of adult patients who underwent the Cox-maze procedure for valvular atrial fibrillation from January 2000 to December 2015. The study data collected included the primary indications for cardiac surgery, perioperative complications and follow-up outcomes data on the successful treatment of AF and restoration of sinus rhythm. Results: We reviewed 144 patient records of which 98 (68.1%) were females. The mean age was 45.0 (SD: 12.4) years. Before surgery, 141 participants had a documented NYHA functional class. Of these, 117 (83.0%) participants were in NYHA class III with a mean ejection fraction of 55% (SD: 12.5). Rheumatic mitral stenosis was the primary indication for surgery in 73 (50.7%) participants. Immediately after surgery, sinus rhythm was restored in 106 (74%) patients. After a mean duration of 5.6 years (SD: 3.3), 104 patients had a documented rhythm. Of these, 81 (76.4%) remained in sinus rhythm. On multivariable analysis, none of the study variables could predict persistent atrial fibrillation Conclusions: Our findings suggest that the Cox-maze procedure is effective in the management of valvular atrial fibrillation in symptomatic patients undergoing open heart surgery.
research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Masters in Medicine. Johannesburg,2018