Efficacy of Cut-and-Sew Surgical Ablation for Atrial Fibrillation in Patients With Giant Left Atria Undergoing Mitral Valve Surgery: A Propensity-Matched Analysis

Surgical management for patients with long-standing persistent (LSP) AF and giant left atria (GLA) associated with mitral valve diseases remains a challenge. We aimed to assess the efficacy of the cut-and-sew maze procedure (CSM) in this subgroup of patients, in terms of maintenance of sinus rhythm (SR), atrial function, and to identify the operative risks of this procedure. A total of 229 patients with LSP-AF underwent CSM at our institution from December 2013 to October 2017. Patients were divided into 2 groups based on LA diameter: NGLA group ( n  = 171), GLA group (≥65 mm, n  = 58). Patients with GLA were propensity score matched to patients without GLA resulting in 45 pairs of patients. Early death occurred in 1 (2.2%) in GLA group and no deaths in NGLA group ( P  = 0.315). Early complications did not differ significantly between the 2 groups. The GLA group showed similar rates of SR on and off antiarrhythmic drugs compared with NGLA group at 2 years (86.36% vs 93.9%, P  = 0.338; 81.82% vs 90.91%, P  = 0.322). At 2 years, LA contraction was comparable between patients with and without GLA (81.81% vs 90.9%, P  = 0.322). Right atrial contraction recovery rate was 96% in NGLA group, and 86.36% in GLA group ( P  = 0.138). Concomitant CSM is effective and feasible for restoration of SR and atrial contraction, for patients with LSP-AF and GLA associated with mitral valve diseases with acceptable operative risks.