Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations

  • Kuh, Ja Hong (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Song, Joon Young (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Kim, Tae Youn (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Kim, Jong Hun (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Choi, Jong Bum (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School)
  • Received : 2016.07.22
  • Accepted : 2016.09.29
  • Published : 2017.06.05
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Abstract

Background: In elderly patients who have atrial fibrillation (AF), surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP), the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. Methods: From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was $8{\pm}11$ (high risk). Results: Only 1 hospital death occurred (4%). The Kaplan-Meier method showed a high 5-year cumulative survival rate (92%). At mean follow‐up of 51 months, 23 patients (89%) had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium ($53.4{\pm}7.5cm$) and the 19 patients who did not have reduction plasty ($48.7{\pm}5.7cm$). Conclusion: In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

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References

  1. Cox JL. Intraoperative options for treating atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg 2001;122:212-5. https://doi.org/10.1067/mtc.2001.116941
  2. Grigioni F, Avierinos JF, Ling LH, et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol 2002;40:84-92. https://doi.org/10.1016/S0735-1097(02)01922-8
  3. Quader MA, McCarthy PM, Gillinov AM, et al. Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Ann Thorac Surg 2004;77:1514-22. https://doi.org/10.1016/j.athoracsur.2003.09.069
  4. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation: the Framingham Study. Stroke 1996;27: 1760-4. https://doi.org/10.1161/01.STR.27.10.1760
  5. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med 1992;116:1-5. https://doi.org/10.7326/0003-4819-116-1-1
  6. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8. https://doi.org/10.1161/01.STR.22.8.983
  7. Gillinov AM, Saltman AE. Ablation of atrial fibrillation with concomitant cardiac surgery. Semin Thorac Cardiovasc Surg 2007;19:25-32. https://doi.org/10.1053/j.semtcvs.2007.01.002
  8. Kim JH, Choi JB, Kuh JH. Right atrial reduction plasty associated with the cox-maze procedure. J Card Surg 2015; 30:544-6. https://doi.org/10.1111/jocs.12542
  9. Choi JB, Kim JH, Cha BK. Outcome of concomitant cox maze procedure with narrow mazes and left atrial volume reduction. Korean J Thorac Cardiovasc Surg 2014;47: 358-66. https://doi.org/10.5090/kjtcs.2014.47.4.358
  10. Kim KH, Kim MH, Choi JB. Left atrial reduction plasty. Ann Thorac Surg 2013;95:1510-1.
  11. Park WK, Lee JW, Kim JB, Jung SH, Choo SJ, Chung CH. Outcomes of surgical atrial fibrillation ablation: the port access approach vs. median sternotomy. Korean J Thorac Cardiovasc Surg 2012;45:11-8. https://doi.org/10.5090/kjtcs.2012.45.1.11
  12. Kim JS, Lee JH, Chang HW, Kim KH. Surgical outcomes of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in valvular heart disease. Korean J Thorac Cardiovasc Surg 2011;44:18-24. https://doi.org/10.5090/kjtcs.2011.44.1.18
  13. Lee SH, Kim JB, Cho WC, et al. The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium. J Thorac Cardiovasc Surg 2011;141:1015-9. https://doi.org/10.1016/j.jtcvs.2010.08.036
  14. Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 2001;38: 1231-66. https://doi.org/10.1016/S0735-1097(01)01587-X
  15. Cox JL, Jaquiss RD, Schuessler RB, Boineau JP. Modification of the maze procedure for atrial flutter and atrial fibrillation: II. Surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 1995;110:485-95. https://doi.org/10.1016/S0022-5223(95)70245-8
  16. Cox JL. Surgical treatment of supraventricular tachyarrhythmia. In: Cohn LH, Edmunds LH, editors. Cardiac surgery in the adult. 2nd ed. New York (NY): McGraw-Hill Medical; 2003. p. 1271-85.
  17. Buber J, Luria D, Sternik L, et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol 2011;58:1614-21. https://doi.org/10.1016/j.jacc.2011.05.051
  18. Kim JB, Yun TJ, Chung CH, Choo SJ, Song H, Lee JW. Long-term outcome of modified maze procedure combined with mitral valve surgery: analysis of outcomes according to type of mitral valve surgery. J Thorac Cardiovasc Surg 2010;139:111-7. https://doi.org/10.1016/j.jtcvs.2009.07.002
  19. Gillinov AM, Sirak J, Blackstone EH, et al. The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg 2005;130: 1653-60. https://doi.org/10.1016/j.jtcvs.2005.07.028
  20. Ad N, Holmes SD. Prediction of sinus rhythm in patients undergoing concomitant Cox maze procedure through a median sternotomy. J Thorac Cardiovasc Surg 2014;148: 881-6. https://doi.org/10.1016/j.jtcvs.2014.04.050
  21. Kim YH, Lee SC, Her AY, et al. Preoperative left atrial volume index is a predictor of successful sinus rhythm restoration and maintenance after the maze operation. J Thorac Cardiovasc Surg 2007;134:448-53. https://doi.org/10.1016/j.jtcvs.2007.02.031
  22. Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Thorac Surg 2006;82:1758-63. https://doi.org/10.1016/j.athoracsur.2006.05.044
  23. Ad N, Henry L, Hunt S, Holmes SD, Halpin L. Results of the Cox-Maze III/IV procedure in patients over 75 years old who present for cardiac surgery with a history of atrial fibrillation. J Cardiovasc Surg (Torino) 2013;54:281-8.

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