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Should We Perform The Cox-maze Procedure In Patients Over 75 Years Old Presenting To Surgery With Atrial Fibrillation? *Niv Ad, Linda Henry, Sharon Hunt, Linda HalpinInova Heart and Vascular Institute, Falls Church, VA OBJECTIVES: The incidence of atrial fibrillation (AF), doubles with each decade after the age 50 and is associated with decreased survival and increased morbidity. Elderly patients are especially vulnerable since they usually have high CHADS score and significantly higher risk of bleeding while on warfarin, therefore, interventions to “cure AF” are of utmost importance in the aging patient. The purpose of this study was to explore the impact of the surgical ablation procedure on elderly patients presenting for cardiac surgery who also experienced AF. METHODS: We identified 44 patients aged 75 presented for valve surgery or CABG and underwent surgical ablation for AF, they were matched to patients ≥ 75 years (n=36) who presented for cardiac surgery, were experiencing AF and did not receive a surgical ablation procedure. Patients were matched on Euroscore and operative risk, status of operation and by controlling for CABG and or valve surgery. Chi square analysis, t-test and Kaplan-Meier survival analysis were used to identify group differences. The Social Security and the National Death Indexes were searched for patient deaths. RESULTS: There were no significant differences between groups on selected preoperative characteristics. The average age for both groups was 79.90 (± 3.22) years, the average EuroSCORE was 9.53 (± 2.44). None of the STS measured perioperative outcomes showed to be statistically significant, (Table 1);. At 24 months for the ablation group, 80% of pts were in sinus rhythm, and 50% were on warfarin, when in half of them the indication was unrelated to AF . No strokes and only 2 major bleeding events with no deaths related were documented for this group. Long term survival analysis demonstrated that patients in the ablation group experienced better long term survival (p=.01) (Figure 1) CONCLUSIONS: Surgical ablation for patients aged 75 years and older did not add operative risk and may be related to improved long term survival post surgery. Patients should not be excluded from surgical ablation based on aged and associated risk only. Consideration should be given to performing surgical ablation on patients aged 75 years and older who present for cardiac surgery and are experiencing atrial fibrillation.  
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