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J Thorac Cardiovasc Surg 2007;134:717-722
© 2007 The American Association for Thoracic Surgery

Evolving Technology

The multi–purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies

Inova Heart and Vascular Institute, Falls Church, Va.

Received for publication January 15, 2007; revisions received March 6, 2007; accepted for publication April 12, 2007.

^_* Address for reprints: Niv Ad, MD, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042. (Email: niv.ad{at}inova.com).

Objective: The maze procedure is the most effective surgical procedure for atrial fibrillation. In recent years, a number of different surgical ablation devices were introduced and gradually replaced the need for the procedure to be performed by using the cut-and-sew technique. In this article a new surgical approach is presented using a full maze IV lesion set, without atriotomies.

Methods: Between January 2005 and June 2006, 12 patients underwent operations with the multi–purse string technique: 9 patients as a combined procedure with coronary artery bypass grafting, 2 patients as a combined procedure with aortic valve replacement, and 1 patient as a standalone procedure. In 5 additional patients, a small left atrial atriotomy was required to ensure the completeness of the mitral valve isthmus lesion. A combination of bipolar radiofrequency and cryothermal energies was used in all cases. All patients were part of our comprehensive follow-up and local atrial fibrillation registry.

Results: No perioperative morality, cerebrovascular accidents/transient ischemic attacks, or both were documented in this series. In a mean follow-up of 13 ± 6 months, 1 late death was documented, and 91% of the patients are free from atrial fibrillation or flutter.

Conclusions: Our experience suggests that the maze IV procedure can be performed without the need for atriotomies by using the multi–purse string approach. The intermediate results are promising, with high rates of success in ablating atrial fibrillation. Future studies should be performed to validate the safety of the use of bipolar radiofrequency devices endocardially on a beating heart.