Long-term outcomes
The median follow-up was 58.9 +/-26.4 months. Freedom from AF is shown
in Figure 2. At 12 months 84.9% of the Cox Maze group were in SR. These
benefits persisted until latest follow-up (80%) and were significantly
superior to the No surgical AF treatment group (P<0.00001).
There were 79 mortalities (33.1%) during the follow-up period. There
was a clear survival advantage of the Cox-Maze group (p=0.02) over the
No Surgical AF treatment group (figure 4). It should be mentioned that
all patients were over 70 years of age at the time of surgery.
There were 74 patients (31.0%) who remained in NYHA 1 on long-term
follow-up. There were clear functional benefits in the Cox-Maze
(p=0.009) compared to No Surgical AF treatment groups (figure 5). On
follow-up echocardiography, the LVF was improved marginally in the
Cox-Maze group compared to the pre-operative LVF (1.0+/-2.2%).
Conversely, the LVF worsened slightly in the control groups. Overall,
the post-operative LVF was not significantly higher in the Cox-Maze
group (55.2+/-8.3%) compared to the No Surgical AF treatment group
(51.1+/-9.6%).
There were 11 cases of stroke in the overall cohort on long-term
follow-up (4.6%). There were 2 patients in the Cox-Maze group (2.9%)
compared to 9 patients in the No Surgical AF treatment group (5.3%).
There were no significant differences (p=0.80) in the long-term freedom
from stroke between the groups.
There were 19 patients who required PPM at long-term follow-up (7.9%).
5 patients in the Cox-Maze group (7.1%) compared to 14 in the No
Surgical AF treatment group (8.3%). There were no significant
differences (p=0.33) in long-term freedom from PPM between the groups.
Only 15 patients in the entire cohort (6.3%) stopped taking oral
anticoagulation at long-term follow-up with no comparable difference
between the groups (p=0.06).