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BACKGROUND: The surgical treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease is still a challenge, because the recurrence rate is high. Cut-and-sew maze procedure is the gold standard for the treatment of atrial fibrillation, but few studies are reported on cut-and-sew procedure used to treat this disease. OBJECTIVE: To evaluate the safety and efficacy of cut-and-sew maze procedure and mitral valve (mechanical valve and biovalve) replacement in the treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease. METHODS: Patients with atrial fibrillation associated with rheumatic mitral valve disease who underwent the cut-and-sew maze procedure and mitral valve replacement in our hospital during April 2014 to October 2017 were retrospectively analyzed; 114 patients were enrolled according to the inclusion and exclusion criteria. By defining 60 mm as the boundary of the left atrial dimension, patients were divided into a non-giant left atrium group (left atrial dimension < 60 mm, n=85) and a giant left atrium group (left atrial dimension ≥ 60 mm, n=29). Perioperative safety indexes and postoperative curative effect were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Region), China (approval No. lunshen-k(2015)33). RESULTS AND CONCLUSION: Intraoperative safety indexes: There were no significant differences in the time of aortic occlusion, intraoperative cardiopulmonary bypass, intraoperative blood loss, operation duration and mitral valve replacement type between the two groups (P > 0.05). Postoperative safety indexes: There were no significant differences in the proportion of secondary thoracotomy after surgery, proportion of electrical cardioversion and temporary pacemaker applications, the time of ventilator use, ICU stay, length of hospitalization, early postoperative drainage volume and the incidence of early postoperative compilations between non-giant left atrium and giant left atrium groups (P > 0.05). Postoperative efficacy analysis: there was no significant difference in the recovery rate of sinus rhythm between non-giant left atrium and giant left atrium groups on the day of surgery, at discharge, and 6 months and 1 year after surgery (P > 0.05). There was no significant difference in cardiac function recovery between non-giant left atrium and giant left atrium groups at 6 months and 1 year after surgery (P > 0.05). These results suggest that cut-and-sew maze procedure and mitral valve replacement for the treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease are highly safe and exhibit encouraging short-term efficacy. [ABSTRACT FROM AUTHOR]