Atrial fibrillation surgery in nonrheumatic mitral valve disease.
Atrial fibrillation (AF) is present in 30-50% of patients presenting for mitral valve surgery. If left untreated, AF in these patients is associated with increased morbidity and, possibly, increased mortality. Therefore, concomitant management of the arrhythmia is indicated in most mitral valve patients with preexisting AF. The cut-and-sew Cox-Maze III procedure is extremely effective, eliminating AF in 80-95%; however, it has been supplanted by newer operations that rely upon alternate energy sources to create lines of conduction block. Early and midterm results are good with a variety of technologies. Choice of lesion set remains a matter of debate, but success of ablation appears to be enhanced by a biatrial lesion set and exceeds 90% in some series. Targeted areas for improvement in combined mitral valve surgery and AF ablation include acceptance of uniform standards for reporting results, development of improved technology for ablation and intraoperative assessment, and creation of instrumentation that facilitates minimally invasive approaches.
Gillinov
Marc
M
The Center for Atrial Fibrillation Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA. gillinom@ccf.org
D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome