Ahmet Zengin, Taylan Adademir, Kaan Kırali

University of Health Sciences, Istanbul Kartal Kosuyolu High Speciality Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey

Keywords: Cox maze IV, myelodysplastic syndrome, syndrome


A long-term maintenance of sinus rhythm in patients undergoing cardiac surgery with atrial fibrillation is only possible with concomitant Cox-Maze IV procedure. Contemporary studies suggest that concomitant biatrial lesion sets produce long-term sinus conversion rates of up to 90%. This procedure holds the potential to improve life quality and even survival of the patients; however, many surgeons are reluctant to perform the same. More than half of the patients with atrial fibrillation undergoing cardiac surgery for different reasons never receive any kind of intervention for atrial fibrillation, which means missing a once-in-a-lifetime opportunity to treat atrial fibrillation. Rate control with anticoagulation remains the only alternative treatment for these patients. Anticoagulation can be a relatively safe option at the time of surgery but may become dangerous or even a contraindication with the patient’s increasing age and a possible development of new diseases. Sinus rhythm can become lifesaving at that point. The objective of this report is to describe a successful surgical treatment of a 74-year-old woman with severe mitral and tricuspid valve insufficiency along with atrial fibrillation. She had mild leucopenia and anemia at the time of surgery without any hematological diagnosis. She was diagnosed with myelodysplastic syndrome six months after the surgery. In addition to valve repairs, the maintenance of sinus rhythm prompted hematologists to treat her without using any anticoagulation medicines. We believe that atrial fibrillation should be addressed during cardiac surgery because the maintenance of sinus rhythm might become crucial during follow-up!

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - AZ; Analysis/Interpretation - AZ; Data Collection - AZ; Writing - AZ; Critical Revision - TA; Final Approval - KK; Statistical Analysis - AZ; Obtained Funding - AZ; Overall Responsibility - TA.

Conflict of Interest

The authors have no conflict of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.