title: Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery.
abstract: BACKGROUND
  Success of the maze procedure after mitral operations with large left atria and permanent atrial fibrillation remains suboptimal. Current technique variations tend to obscure the decision-making algorithm in these patients. A single energy-source approach for the surgical management of patients with large left atria and permanent atrial fibrillation is presented.
  
  
  METHODS
  From January 2003 to July 2005, 71 consecutive drug-resistant patients with permanent atrial fibrillation and left atrial enlargement who required mitral valve surgery underwent aggressive left atrial reduction combined with left-sided only irrigated radiofrequency unipolar maze. Left atrial dimensions were measured by transesophageal echo anterior-to-posterior leading edge-to-edge standardized protocol. There were 39 men (54.9%) and 32 women (45.1%), and their mean age was 71.9 +/- 9.5 years. Mean duration of atrial fibrillation was 49.3 +/- 58.0 months.
  
  
  RESULTS
  All patients underwent left atrial reduction with identical Cox-maze III pulmonary vein and appendage isolation including mitral annular connection, followed by appendage suture closure. Left atrial size was reduced from 6.7 +/- 1.2 cm to 4.3 +/- 0.6 cm (p = 0.001). Mitral valve repair was performed in 55 patients (76.1%) and replacement in 17 (23.9%). The 30-day mortality was 4.2% (3/71). Postoperative length of stay was 8.8 +/- 5.7 days, with 56 (82.4%) of 68 patients discharged in normal sinus rhythm. P-wave sinus rhythm was 93.8% between 7 and 12 months and 92.0% for patients with 1 year or more of follow-up.
  
  
  CONCLUSIONS
  Left atrial reduction combined with a left atrial only single energy-source radiofrequency maze procedure is an effective treatment for patients with permanent atrial fibrillation undergoing concomitant mitral operations.
authors.affiliation: Cardiac Surgical Associates MAZE Investigators, St. Petersburg, Florida 33701, USA. vbadhwar@heartsurgery-csa.com
authors.forename: Vinay
authors.initials: V
authors.lastname: Badhwar
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Rovin
authors.forename: Gail
authors.initials: G
authors.lastname: Davenport
authors.forename: J Crayton
authors.initials: JC
authors.lastname: Pruitt
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lazzara
authors.forename: George
authors.initials: G
authors.lastname: Ebra
authors.forename: Gary H
authors.initials: GH
authors.lastname: Dworkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D016896:Treatment Outcome