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J Thorac Cardiovasc Surg 2008;136:1257-1264
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

The effects of the Cox maze procedure on atrial function

Rochus K. Voeller, MD, Andreas Zierer, MD, Shelly C. Lall, MD, Shun–ichiro Sakamoto, MD, Nai–Lun Chang, BS, Richard B. Schuessler, PhD, Marc R. Moon, MD, Ralph J. Damiano, Jr., MD*

Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes–Jewish Hospital, St Louis, Mo

Received for publication November 24, 2007; accepted for publication January 24, 2008.

* Address for reprints: Ralph J. Damiano, Jr, MD, Washington University School of Medicine, Barnes–Jewish Hospital, Suite 3108 Queeny Tower, 1 Barnes–Jewish Hospital Plaza, St. Louis, MO 63110. (Email: damianor{at}wustl.edu).

Objective: The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model.

Methods: After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure–volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group.

Results: Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging–derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days.

Conclusions: Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wall motion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation.

Abbreviations and Acronyms AF = atrial fibrillation; BSA = body surface area; LA = left atrium; LAA = left atrial appendage; LAAE = left atrial active emptying percentage of total emptying; LAAEI = left atrial active emptying index; LACC = left atrial volume change; LAEF = left atrial active ejection fraction; LAEI = left atrial active emptying index; LAmax = maximal left atrial volume; LAmin = minimal left atrial volume; LAPE = left atrial passive percentage of total emptying; LAPEI = left atrial passive emptying index; LAPTE = left atrial percentage total emptying; LArel max = relative maximal left atrial volume; LArel min = relative minimal left atrial volume; LV = left ventricular; LVSV = left ventricular stroke volume; MRI = magnetic resonance imaging; PV = pulmonary vein; RA = right atrium; RF = radiofrequency






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