Average Cardiopulmonary Bypass Time for Combined Maze, Mitral Valve Replacement, and Left Atrial Appendage Removal
Direct Answer Based on Available Evidence
The available guidelines and research do not provide a specific average pump time for this exact combination of procedures, but based on the evidence for maze procedure combined with mitral valve surgery, the cardiopulmonary bypass time typically ranges from 150-174 minutes, with aortic cross-clamp times of 95-122 minutes. 1, 2, 3
Evidence-Based Pump Time Estimates
Combined Maze and Mitral Valve Surgery
Cardiopulmonary bypass time for maze procedure combined with mitral valve repair or replacement averages 162-174 minutes in contemporary series 1, 3
Aortic cross-clamp time for the combined procedure averages 98-122 minutes 1, 3
The maze procedure itself adds approximately 21 minutes of additional aortic cross-clamp time when performed with mitral valve surgery 3
Specific Study Data
In a matched control study, maze combined with mitral valve surgery required 174.0 ± 38.8 minutes of cardiopulmonary bypass time versus 150.1 ± 54.4 minutes for mitral valve surgery alone (p = 0.032) 1
The same study showed aortic cross-clamp time of 122.5 ± 30.7 minutes for the combined procedure versus 95.8 ± 38.2 minutes for mitral valve surgery alone (p = 0.0012) 1
Another series reported mean cardiopulmonary bypass time of 162 ± 38 minutes and aortic cross-clamp time of 98 ± 22 minutes for radiofrequency maze with mitral valve surgery 3
Important Clinical Context
Why the Maze Adds Minimal Time
The maze procedure adds little complexity when performed with mitral valve surgery because the left atrium is already open for the valve procedure 4
The additional time required is primarily for creating the ablation lesions, which can be done efficiently with modern radiofrequency or cryoablation technology 4
Left Atrial Appendage Removal
Left atrial appendage ligation or amputation is commonly performed during maze procedures and does not significantly add to operative time since it is part of the standard maze lesion set 4
The maze procedure includes "a lesion to the stump of the ligated or amputated left atrial appendage" as part of the standard technique 4
Safety Considerations
Operative Risk
The maze procedure does not appear to increase operative risk of mortality in properly selected patients when added to mitral valve surgery 4
Studies show no significant difference in hospital mortality between maze combined with mitral valve surgery (4.5%) versus mitral valve surgery alone (2.2%) 2
Common Complications
Pacemaker requirement occurs in approximately 5-19% of patients after maze procedure due to sinus node dysfunction 5, 3
Re-exploration for bleeding is not significantly increased by adding the maze procedure 1
Stroke risk may actually be reduced by the maze procedure when combined with left atrial appendage removal, though this remains controversial 4, 6
Clinical Pitfalls to Avoid
Do not underestimate the importance of surgeon experience - these pump times reflect experienced surgeons performing the procedure 1, 2
Patients with extremely enlarged left atria (>6.7 cm) may require left atrial reduction, which can add additional time to the procedure 7
The full maze procedure (Cox-Maze III or IV) requires more time than "mini-maze" procedures but provides superior rhythm control (75-95% success versus 10-40% without ablation) 4