Treating Atrial Fibrillation During Planned Valve Surgery.
A patient scheduled for mitral valve repair was not offered a concomitant Maze procedure — until our review.
This is a composite narrative based on common clinical scenarios. Patient details have been anonymized and combined for educational purposes. Individual results vary based on specific clinical circumstances.
A 63-year-old attorney from New York was scheduled for mitral valve repair for severe degenerative regurgitation. She also had paroxysmal atrial fibrillation that had failed two catheter ablation attempts. Her surgeon planned to repair the valve but did not include a surgical Maze procedure or left atrial appendage closure.
What our Heart Team found.
Our Heart Team review identified a missed opportunity. The 2020 ACC/AHA guidelines provide a Class IIa recommendation for surgical ablation of atrial fibrillation performed concomitantly with other cardiac surgery. Given her failed catheter ablations and the fact that the chest would already be open, adding a Cox-Maze IV procedure and LAA ligation would address her AFib with minimal additional risk while potentially eliminating her need for long-term anticoagulation.
What happened next.
She discussed our findings with her surgeon, who agreed to add the Maze procedure. She underwent successful mitral repair with concomitant Cox-Maze IV and LAA ligation. At 6-month follow-up, she was in normal sinus rhythm, off anticoagulation, and symptom-free.
When cardiac surgery is already planned, concomitant treatment of atrial fibrillation should always be considered. The guidelines support this approach, yet it is frequently overlooked.
