JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Takeshi Shimamoto
Tadashi Ikeda
Masashi Komeda
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marui, A.
Right arrow Articles by Komeda, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marui, A.
Right arrow Articles by Komeda, M.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2006;132:1047-1053
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

A novel atrial volume reduction technique to enhance the Cox maze procedure: Initial results

Akira Marui, MD, PhD, Takeshi Nishina, MD, PhD, Keiichi Tambara, MD, PhD, Yoshiaki Saji, MD, Takeshi Shimamoto, MD, Masahiko Nishioka, MD, Tadashi Ikeda, MD, PhD, Masashi Komeda, MD, PhD*

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Received for publication March 6, 2006; revisions received July 3, 2006; accepted for publication July 7, 2006.

* Address for reprints: Masashi Komeda, MD, PhD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara, Sakyo, Kyoto 606-8507, Japan. (Email: komelab{at}kuhp.kyoto-u.ac.jp).

OBJECTIVE: Large left atrial diameter is reported to be a predictor for recurrent atrial fibrillation after the Cox maze procedure, and left atrial diameter by itself influences the chance of sinus rhythm recovery, as well as maintenance of sinus rhythm. However, additional cut-and-sew procedures to decrease left atrial diameter extend operative time and can cause bleeding. Thus we developed a no-bleeding, faster, and therefore less invasive left atrial volume reduction technique to enhance the Cox maze procedure.

METHODS: The modified Cox maze III procedure with cryoablation or the left atrial maze procedure in association with mitral valve surgery was performed in 80 patients with atrial fibrillation and enlarged left atria (≥60 mm). Among them, 44 patients had the concomitant volume reduction technique (VR group); continuous horizontal mattress sutures for left atrial plication were placed on the left atrial wall along the pulmonary vein isolation line. Cryoablation was applied to the suture line so that the plicated left atrium is anatomically and electrically isolated. Another 36 patients did not have the volume reduction technique (control group).

RESULTS: The VR group had preoperative left atrial diameters similar to those of the control group (67.1 ± 7.8 vs 64.5 ± 6.7 mm) and a longer preoperative duration of atrial fibrillation (14.1 ± 5.4 vs 9.5 ± 5.1 years, P < .05) but had smaller postoperative left atrial diameters (47.6 ± 6.3 vs 62.1 ± 7.9 mm, P < .01). There were no differences in mean crossclamp/bypass time and chest tube drainage for 12 hours between the groups. Twelve months after surgical intervention, the sinus rhythm recovery rate of the VR group was better than that of the control group (90% vs 69%, P < .05).

CONCLUSIONS: Even in patients with long-standing atrial fibrillation and an enlarged left atrium, maze procedures concomitant with the novel left atrial volume reduction technique improved the sinus rhythm recovery rate without increasing complications. Although further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.

Abbreviations and Acronyms A/E = ratio of peak A to peak E wave; AF = atrial fibrillation; ECG = electrocardiography; LA = left atrium; LAD = left atrial diameter; PV = pulmonary vein; RA = right atrium; SR = sinus rhythm; VR = volume reduction




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Marui, Y. Saji, T. Nishina, E. Tadamura, S. Kanao, T. Shimamoto, N. Sasahashi, T. Ikeda, and M. Komeda
Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function.
J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1297 - 1305.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. Marui, K. Tambara, E. Tadamura, Y. Saji, N. Sasahashi, T. Ikeda, T. Nishina, and M. Komeda
A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium
Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 308 - 312.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.