A new procedure for chronic atrial fibrillation: bilateral appendage-preserving maze procedure.
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.
Isobe
F
F
Department of Cardiovascular Surgery, Osaka National Hospital, Japan. isobe@onh.go.jp
Kumano
H
H
Ishikawa
T
T
Sasaki
Y
Y
Kinugasa
S
S
Nagamachi
K
K
Kato
Y
Y
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
D009320:Atrial Natriuretic Factor