["Cox/Maze-III operation" as surgical therapy of chronic atrial fibrillation during mitral valve and atrial septal defect II operation].
OBJECTIVE
Atrial fibrillation is associated with significant morbidity and mortality. The increased risk of thromboembolism makes constant anti-coagulation necessary, while the absence of atrial contraction worsens the hemodynamic situation. In this study we examined the results of simultaneous surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" while mitral valve surgery and atrial septal closure.


METHODS
Between February 1995 and July 1997 sixteen patients aged 50 to 72 y (mean: 59 y) underwent open heart surgery (mitral valve replacement n = 10, reconstruction n = 3; mitral valve reconstruction and atrial septal closure n = 1, atrial septal closure n = 1, thrombectomy from left atrium n = 1) and "Cox/Maze-III-procedure" in one session. Preoperative duration of chronic atrial fibrillation was between 2 and 12 y (mean: 5.0 y). The patients were examined preoperatively and postoperatively 3, 6, 12, and 24 months after surgery using the following methods: transesophageal echocardiography (TEE), ECG, long-term ECG, and stress ergometry.


RESULTS
During the early postoperative period (< 7 d) all of the patients were in sinus rhythm or atrial pacing; eight patients intermittently had atrial fibrillation. In the follow-up period from 1 to 27 months (mean 14 months), 15 patients have a stable sinus rhythm (94%). One patient, preoperatively known to have intermittent tachybradycardia, received a pacemaker 2 months postoperatively for sinus bradycardia. Postoperatively in TEE patients showed left atrial contraction with improvement of hemodynamic situation. Stress ergometry 6 months postoperatively showed lower increasements of heart rate, at 12 months normal frequency.


CONCLUSIONS
The surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" can be performed combined with other heart operations without increased perioperative or postoperative risks. The Maze-procedure is an effective surgical therapy of chronic atrial fibrillation. Postoperatively there is an improvement of the hemodynamic situation because of sinus rhythm and synchrone atrioventricular contraction.
Musci
M
M
Abt. Herz-, Thorax-und Gefässchirurgie, Deutsches Herzzentrum Berlin.
Pasic
M
M
Siniawski
H
H
Lehmkuhl
H
H
Edelmann
B
B
Hetzer
R
R
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D013536:Suture Techniques; D017131:Thrombectomy; D016896:Treatment Outcome
"Cox/Maze-III-Operation" als chirurgische Therapie des chronischen Vorhofflimmerns während Mitralklappen-und ASD-II-Operation.