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J Thorac Cardiovasc Surg 1994;108:1049-1055
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease

Yoshio Kosakai, MD (by invitation), Akira T. Kawaguchi, MD (by invitation), Fumitaka Isobe, MD (by invitation), Yoshikado Sasako, MD (by invitation), Kiyoharu Nakano, MD (by invitation), Kiyoyuki Eishi, MD (by invitation), Norio Tanaka, BS (by invitation), Yoshitsugu Kito, MD (by invitation), Yasunaru Kawashima, MD


Osaka, Japan

Supported in part by the Research Grant for Cardiovascular Diseases (6C-4) from the Ministry of Health and Welfare and by a grant from the Japan Cardiovascular Research Foundation (1992).

Address for reprints: Yoshio Kosakai, MD, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565, Osaka, Japan.

Abstract

Between April 1992 and October 1993, we combined a modified maze procedure with mitral valve repair (n = 26) or replacement (n = 36) in 62 patients with atrial fibrillation, including 16 patients undergoing reoperation. Associated procedures included aortic valve operation (n = 22), tricuspid annuloplasty (n = 28), atrial plication (n = 10), and others (n = 3). Duration of atrial fibrillation varied from 0.1 to 23 years (average 8.3 ± 6.4 years), the f-wave voltage ranged from 0 to 0.45 mV (0.16 ± 0.09 mV), and cardiothoracic ratio varied from 46% to 85% (64% ± 9%). We modified the maze atriotomies to preserve the sinus node artery and used cryoablation to simplify procedures. Aortic crossclamp time was 142 ± 25 minutes and cardiopulmonary bypass time 226 ± 34 minutes. No early or late deaths occurred in a total of 783 patient-months of follow-up. In 52 patients (84%) who regained atrial rhythm, an atrial A-wave was detected in 84% for transtricuspid flow and in 71% for transmitral flow. One patient with sinus rhythm had an episode of transient neurologic ischemia 4 months after mechanical valve implantation. The 10 patients who remained in atrial fibrillation had preoperative fibrillation for a significantly longer time than the rest of the patients with atrial rhythm (14.8 versus 7.2 years, p < 0.001) and a larger left atrial dimension (70 versus 58 mm, p < 0.01). Nonetheless, no variable alone could have predicted postoperative rhythm for individual patients. The results suggest that the maze procedure is safe and effective and therefore should be considered for patients with chronic atrial fibrillation undergoing mitral valve operations. (J THORACCARDIOVASCSURG1994;108:1049-55)




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Ann. Thorac. Surg., August 1, 1997; 64(2): 394 - 398.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
T. Sueda, H. Nagata, K. Orihashi, S. Morita, K. Okada, M. Sueshiro, S. Hirai, and Y. Matsuura
Efficacy of a Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Operations
Ann. Thorac. Surg., April 1, 1997; 63(4): 1070 - 1075.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
T. Sueda, H. Nagata, H. Shikata, K. Orihashi, S. Morita, M. Sueshiro, K. Okada, and Y. Matsuura
Simple Left Atrial Procedure for Chronic Atrial Fibrillation Associated With Mitral Valve Disease
Ann. Thorac. Surg., December 1, 1996; 62(6): 1796 - 1800.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
J. Kobayashi, Y. Kosakai, F. Isobe, Y. Sasako, K. Nakano, K. Eishi, and Y. Kawashima
RATIONALE OF THE COX MAZE PROCEDURE FOR ATRIAL FIBRILLATION DURING REDO MITRAL VALVE OPERATIONS
J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1216 - 1222.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
T. Sueda, H. Shikata, N. Mitsui, H. Nagata, and Y. Matsuura
MYOCARDIAL INFARCTION AFTER A MAZE PROCEDURE FOR IDIOPATHIC ATRIAL FIBRILLATION
J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 549 - 550.
[Full Text]

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 Ann. Thorac. Surg.Home page
J. Kobayashi, Y. Kosakai, and Y. Kawashima
Maze Procedure and Anomalous Coronary Artery Repair
Ann. Thorac. Surg., March 1, 1996; 61(3): 1008 - 1011.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
J. L. Blackshear and J. A. Odell
Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients With Atrial Fibrillation
Ann. Thorac. Surg., February 1, 1996; 61(2): 755 - 759.
[Abstract] [Full Text]

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 CirculationHome page
Y. Kosakai, A. T. Kawaguchi, F. Isobe, Y. Sasako, K. Nakano, K. Eishi, Y. Kito, and Y. Kawashima
Modified Maze Procedure for Patients With Atrial Fibrillation Undergoing Simultaneous Open Heart Surgery
Circulation, November 1, 1995; 92(9): 359 - 364.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
J. L. Cox, J. P. Boineau, R. B. Schuessler, R. D. B. Jaquiss, and D. G. Lappas
MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATIONI. Rationale and surgical results
J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 473 - 484.
[Abstract] [Full Text]

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 CirculationHome page
J. Tamai, Y. Kosakai, T. Yoshioka, E. Ohnishi, H. Takaki, Y. Okano, and Y. Kawashima
Delayed Improvement in Exercise Capacity With Restoration of Sinoatrial Node Response in Patients After Combined Treatment With Surgical Repair for Organic Heart Disease and the Maze Procedure for Atrial Fibrillation
Circulation, May 1, 1995; 91(9): 2392 - 2399.
[Abstract] [Full Text]


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