Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Outcome of Concomitant Cox Maze Procedure with Narrow Mazes and Left Atrial Volume Reduction

  • Choi, Jong Bum (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Kim, Jong Hun (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Cha, Byong Ki (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School)
  • Received : 2013.11.25
  • Accepted : 2014.02.17
  • Published : 2014.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To improve sinus rhythm conversion, the Cox maze III procedure with narrow mazes (width: ${\leq}3.0cm$) was performed in combination with left atrial volume reduction. Methods: From October 2007 to April 2013, 87 patients with atrial fibrillation (paroxysmal in 3, persistent in 14, and permanent in 70) underwent the Cox maze procedure concomitant with another cardiac procedure. They were followed-up with serial electrocardiographic and echocardiographic studies. We used 24-hour Holter monitoring tests to evaluate postoperatively symptomatic patients. Results: At the mean follow-up time of 36.4 months, 81 patients (94.2%) had sinus rhythm and two were on anti-arrhythmic medication (one on a beta-blocker and the other on amiodarone). Five patients (5.8%) with postoperative recurrent and persistent atrial fibrillation never experienced sinus rhythm conversion; however, they did not require any medication for rate control. On postoperative echocardiography, the left atrial A waves were more frequently observed after concomitant mitral valve repair than after concomitant mitral valve replacement (82.4% vs. 40.4%, respectively; p<0.001). Conclusion: For the Cox maze procedure, narrow mazes and atrial volume reduction resulted in excellent sinus rhythm conversion without the preventive use of anti-arrhythmic drugs, and they did not affect the presence of the left atrial A waves on echocardiography.

Keywords

References

  1. Cox JL. Intraoperative options for treating atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg 2001;122:212-5. https://doi.org/10.1067/mtc.2001.116941
  2. Grigioni F, Avierinos JF, Ling LH, et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol 2002;40:84-92. https://doi.org/10.1016/S0735-1097(02)01922-8
  3. Quader MA, McCarthy PM, Gillinov AM, et al. Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Ann Thorac Surg 2004;77:1514-22. https://doi.org/10.1016/j.athoracsur.2003.09.069
  4. Cox JL, Schuessler RB, D'Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991;101:569-83.
  5. Gaynor SL, Diodato MD, Prasad SM, et al. A prospective, single-center clinical trial of a modified Cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg 2004;128:535-42. https://doi.org/10.1016/j.jtcvs.2004.02.044
  6. Blomstrom-Lundqvist C, Johansson B, Berglin E, et al. A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J 2007;28:2902-8. https://doi.org/10.1093/eurheartj/ehm378
  7. Khargi K, Hutten BA, Lemke B, Deneke T. Surgical treatment of atrial fibrillation; a systematic review. Eur J Cardiothorac Surg 2005;27:258-65. https://doi.org/10.1016/j.ejcts.2004.11.003
  8. Choi JB, Park HK, Kim KH, et al. Predictive factors of sustained sinus rhythm and recurrent atrial fibrillation after the maze procedure. Korean J Thorac Cardiovasc Surg 2013;46:117-23. https://doi.org/10.5090/kjtcs.2013.46.2.117
  9. Kim KH, Kim MH, Choi JB. Left atrial reduction plasty. Ann Thorac Surg 2013;95:1510-1.
  10. Yanagawa B, Holmes SD, Henry L, Hunt S, Ad N. Outcome of concomitantCox-maze III procedure using an argon- based cryosurgical system: a single-center experience with 250 patients. Ann Thorac Surg 2013;95:1633-9. https://doi.org/10.1016/j.athoracsur.2013.02.015
  11. Park WK, Lee JW, Kim JB, Jung SH, Choo SJ, Chung CH. Outcomes of surgical atrial fibrillation ablation: the port access approach vs. median sternotomy. Korean J Thorac Cardiovasc Surg 2012;45:11-8. https://doi.org/10.5090/kjtcs.2012.45.1.11
  12. Kim JS, Lee JH, Chang HW, Kim KH. Surgical outcomes of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in valvular heart disease. Korean J Thorac Cardiovasc Surg 2011;44:18-24. https://doi.org/10.5090/kjtcs.2011.44.1.18
  13. Lee SH, Kim JB, Cho WC, et al. The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium. J Thorac Cardiovasc Surg 2011;141:1015-9. https://doi.org/10.1016/j.jtcvs.2010.08.036
  14. Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in Collaboration With the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 2001;38:1231-66. https://doi.org/10.1016/S0735-1097(01)01587-X
  15. Cox JL, Jaquiss RD, Schuessler RB, Boineau JP. Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 1995;110:485-95. https://doi.org/10.1016/S0022-5223(95)70245-8
  16. Cox JL. Surgical treatment of supraventricular tachyarrhythmia. In: Cohn LH, Edmunds LH, editors. Cardiac surgery in the adult. 2n ed. New York: McGraw-Hill Medical;2003. p. 1271-85.
  17. Buber J, Luria D, Sternik L, et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol 2011;58:1614-21. https://doi.org/10.1016/j.jacc.2011.05.051
  18. Kim JB, Yun TJ, Chung CH, Choo SJ, Song H, Lee JW. Long-term outcome of modified maze procedure combined with mitral valve surgery: analysis of outcomes according to type of mitral valve surgery. J Thorac Cardiovasc Surg 2010;139:111-7. https://doi.org/10.1016/j.jtcvs.2009.07.002
  19. Tinetti M, Costello R, Cardenas C, Piazza A, Iglesias R, Baranchuk A. Persistent atrial fibrillation is associated with inability to recover atrial contractility after MAZE IV surgery in rheumatic disease. Pacing Clin Electrophysiol 2012;35:999-1004. https://doi.org/10.1111/j.1540-8159.2012.03458.x
  20. Gillinov AM, Bhavani S, Blackstone EH, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg 2006;82:502-13. https://doi.org/10.1016/j.athoracsur.2006.02.030
  21. Barnett SD, Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg 2006;131:1029-35. https://doi.org/10.1016/j.jtcvs.2005.10.020
  22. Beyer E, Lee R, Lam BK. Point: minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results. J Thorac Cardiovasc Surg 2009;137:521-6. https://doi.org/10.1016/j.jtcvs.2008.11.031
  23. Melo J, Santiago T, Aguiar C, et al. Surgery for atrial fibrillation in patients with mitral valve disease: results at five years from the International Registry of Atrial Fibrillation Surgery. J Thorac Cardiovasc Surg 2008;135:863-9. https://doi.org/10.1016/j.jtcvs.2007.08.069

Cited by

  1. Right Atrial Reduction Plasty Associated with the Cox‐Maze Procedure vol.30, pp.6, 2014, https://doi.org/10.1111/jocs.12542
  2. Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations vol.50, pp.3, 2014, https://doi.org/10.5090/kjtcs.2017.50.3.171