Modified cox maze procedure for atrial fibrillation with mitral valve diseaset.
OBJECTIVE
To determine early term results of the modified Cox maze procedure for curing atrial fibrillation (AF) associated with mitral valve disease.


METHODS
Between January and December 2000, 10 consecutive patients with AF underwent the modified Cox maze procedure with mitral valve repair in 2 and replacement in 8. The associated procedure included 3 aortic valve replacements, 1 tricuspid annuloplasty, and 2 atrial septal defect closures. There were 5 males and 5 females, with ages ranging from 19 to 52 years (mean = 38.3 years). Pre-operative-existing AF time varied from 4 to 146 months (mean = 41.1 months), and left atrial dimension varied from 4.50 to 6.89 cm (mean 5.51 cm). The authors modified the maze atriotomies to preserve the sinus node artery and used cryoablation, incision and suture to simplify the procedures.


RESULTS
Seven cases (70%) regained sinus rhythm and 3 cases (30%) still remained in AF. Two cases (double valve replacement) needed intraaortic balloon pump. Two of them developed cardiac tamponade 1 month post-operatively, (one in sinus rhythm case and another one in AF). Those 3 patients who remained in AF had a longer pre-operative existing AF-time and larger left atrial dimension but it was insignificant (p = 0.227 and p = 0.187 respectively). There was no early or late mortality.


CONCLUSIONS
The pertaining results suggest that the modified Cox maze procedure has satisfactory effectiveness to cure atrial fibrillation, restore atrioventricular synchrony and preserve atrial transport function in the patients having AF associated with mitral valve disease.
Ngodngamthaweesuk
Montien
M
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Boonkasem
Somboon
S
Subhannachart
Wises
W
Attanawanich
Sukasom
S
Supakul
Voravit
V
Masnaragorn
Pornpimol
P
D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome