title: A new procedure for chronic atrial fibrillation: bilateral appendage-preserving maze procedure.
abstract: BACKGROUND
  Atrial transport and atrial natriuretic peptide secretion is severely reduced from normal after the maze III procedure. To improve these factors, we developed a bilateral appendage-preserving maze procedure (BAP-maze).
  
  
  METHODS
  Forty-six patients with chronic atrial fibrillation who underwent the BAP-maze procedure were compared with 40 patients who underwent the maze III procedure. The ratio of the peak velocity of the A and E waves of transmitral flow (transthoracic pulsed Doppler echocardiography), the left atrial appendage ejection fraction (transesophageal echocardiography), and the atrial natriuretic peptide secretory reserve during treadmill exercise test were measured at 6 months postoperatively.
  
  
  RESULTS
  Sinus rhythm was restored in 44 patients (95.7%) by the BAP-maze procedure and in 39 patients (97.5%) by the maze III procedure. The ratio of the peak velocity of the A and E waves was 0.52 +/- 0.22 in the BAP-maze group and 0.25 +/- 0.19 in the maze III group (p < 0.0001). The left atrial appendage ejection fraction was 44.7% +/- 11.5%, and the atrial natriuretic peptide secretory reserve was greater in the BAP maze group (p = 0.037).
  
  
  CONCLUSIONS
  The BAP-maze procedure improved atrial transport and atrial natriuretic peptide secretion as well as simplifying the maze operation, without decreasing its effectiveness against atrial fibrillation.
authors.affiliation: Department of Cardiovascular Surgery, Osaka National Hospital, Japan. isobe@onh.go.jp
authors.forename: F
authors.initials: F
authors.lastname: Isobe
authors.forename: H
authors.initials: H
authors.lastname: Kumano
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Sasaki
authors.forename: S
authors.initials: S
authors.lastname: Kinugasa
authors.forename: K
authors.initials: K
authors.lastname: Nagamachi
authors.forename: Y
authors.initials: Y
authors.lastname: Kato
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D016275:Atrial Function; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology
chemical_list: D009320:Atrial Natriuretic Factor