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J Thorac Cardiovasc Surg 2007;133:395-396
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr W. Randolph Chitwood (Greenville, NC). Thank you, Dr Mitchell. I rise first to congratulate Dr Damiano, Dr Lall, and their associates for collating, analyzing and presenting these important data. Dr Lall, your presentation was absolutely excellent. I reviewed the manuscript in detail in advance and have several comments and a few questions.

Clearly, Dr Jim Cox established the gold standard for a procedure to relieve patients of AF, both intermittent and continuous AF. The seminal investigative and clinical work of Dr Cox and Dr Bonieau at Washington University eventuated in the CM III procedure, which was described first in the Journal of Cardiothoracic and Vascular Surgery in 1995, also bears mention. Through detailed intraoperative mapping, he finally settled on an effective right and left atrial incision set that relieved more than 95% of patients from AF. New lesion sets in the CM III procedure at that time improved both right and left atrial transport and decreased the need for pacemakers. Despite these impressive results, the complexity of creating surgical lesions and the morbidity, especially in inexperienced hands, precluded the widespread adoption of the CM III procedure, despite these obvious advantages that Dr Lall has shown us. This is especially true when combined with mitral valve surgery and mitral valve repair.

Dr Damiano’s work has continued in this illustrious shadow, with attempts to determine an effective operative method that most surgeons can perform in a reasonable time with minimal complications. The procedure described in this presentation used bipolar RF ablation, with most lesions approximating those of the CM III procedure. However, there were differences in the lesion sets.

The authors have compared 154 patients undergoing traditional cut-and-sew operations with 88 patients undergoing the new operation, which has been dubbed here as the CM IV procedure. Because a serial patient . . . [Full Text of this Article]

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The effect of ablation technology on surgical outcomes after the Cox-maze procedure: A propensity analysis

Shelly C. Lall, Spencer J. Melby, Rochus K. Voeller, Andreas Zierer, Marci S. Bailey, Tracey J. Guthrie, Marc R. Moon, Nader Moazami, Jennifer S. Lawton, and Ralph J. Damiano, Jr
J. Thorac. Cardiovasc. Surg. 2007 133: 389-396. [Abstract] [Full Text] [PDF]