Abstract 11867: Late Stroke Rates After Maze Procedure

Introduction: Late stroke can affect quality of life after cardiac surgery. Atrial fibrillation is the most common cardiac arrhythmia and raises the risk of stroke; however, the incidence of late stroke after the Maze procedure has not been determined. Methods: We conducted a retrospective review of 4021 patients who underwent cardiac surgery at our institution between 2000 and 2013. Results: Follow-up data were obtained from 88% of patients at a mean of 4.8±3.4 years. Among these patients, 2.4% (95/4021) experienced symptomatic late stroke (mean period after surgery was 55±35 months, and the mean age was 72±13 years). About 32% (30/95) of patient strokes were caused from atrial fibrillation, 2% (2/95) from hemorrhagic events, 3% (3/95) from cerebral artery diseases, and 63% (60/95) from unknown causes. Among 345 of the 4021 patients who underwent the Maze procedure (Full Maze: 157, LA Maze: 132, PV isolation: 56), 70.5% have remained in sinus rhythm as of their last follow-up. Just 4.3% (15/345) of patients that underwent the Maze procedure had a late stroke during the follow-up period. Of the 15 patients who had a late stroke, 10 failed the Maze procedure and remained in atrial fibrillation. In 60% (9/15) of patients experiencing a late stroke after the Maze procedure, the LA appendage was not closed at the time of surgery. Conclusions: The cause of late stroke after cardiovascular surgery was atrial fibrillation in not less than 30% of patients. The incidence of late stroke after the Maze procedure was 4.3%, which was relatively low considering these patients had arrhythmia problems before the operation (2.4% of all cardiac patients experienced a late stroke). Unsuccessful cases of the Maze procedure and non-LA appendage closure were considered risk factors for late stroke. When patients have atrial fibrillation prior to surgery, we recommend a concomitant Maze procedure or at least LA appendage closure to reduce the incidence of late stroke.