BACKGROUD: More and more older patients experiencing atrial
fibrillation（AF）with other structural heart diseases select the
constant Cox-Maze IV procedure during cardiac surgery, but few studies
have reported whether the older patients benefited from the Cox-Maze IV
procedure. The purpose of this report is to present a retrospective
analysis of the use of the Cox-Maze IV procedure in the elderly.
METHODS: All participants in our center who underwent the
concomitant Cox-Maze IV procedure from January 2011 to September 2018
were included in the study. The clinical data of the patients were
analyzed, and inclusion and exclusion criteria were implemented.
Multivariate analysis was performed to evaluate the effect of the
constant Cox-Maze IV procedure on elderly patients with AF.
RESULTS: A total of 57 patients aged ≥70 years (73.00±2.68
years) were compared to 269 patients aged <70 years
(56.94±8.99 years). During follow-up, atrial fibrillation recurred in 79
(24.23%) patients. The total sinus maintenance rates were 88.7%,
84.5%, and 74.9% after 1, 2, and 3 years, respectively. In
multivariable models, factors of aging [HR: 1.84 (1.02-3.32),
p<0.05], female sex [HR: 1.72 (1.08-2.74),
p<0.05], hypertension [HR: 2.16 (1.21-3.83),
p<0.05], left atrial diameter [HR: 1.05 (1.03-1.08),
p<0.05], and aortic surgery [HR: 0.52 (0.29-0.94),
p<0.05] were associated with AF recurrence.
CONCLUSIONS: Aging is a novel risk factor for atrial
fibrillation recurrence. Patient sex, age, left atrial diameter, and
hypertension should all be taken into account in deciding if elderly
patients suffering from AF should undergo the Cox-Maze procedure.
Keywords: Atrial fibrillation; Cox-Maze IV; Risk factor;