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Maze atrial fibrillation

Yosuke Ishii
Fundamental procedure of arrhythmia surgery is to bock conduction of macro-reentry or focal activation. Traditional "cut and sew" technique is effective to make a conduction block without any special devices although it is time consuming and there is some bleeding risk. Surgical ablation devices are easily able to make a conduction block during surgery. It could undergo the minimally invasive cardiovascular surgery (MICS) -maze procedure through the right mini thoracotomy. It is most important to make complete conduction block because incomplete ablation causes residual conduction, resulting in recurrence of atrial fibrillation or atrial tachycardia...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Shun-Ichiro Sakamoto, Atsushi Hiromoto, Yosuke Ishii, Takashi Sasaki, Yasuo Miyagi, Takashi Nitta
PURPOSE: We examined the outcome of modified-maze procedures reflecting a single-center strategy in the treatment of atrial fibrillation (AF) associated with atrial septal defect (ASD) in adults. METHODS: A retrospective chart review was performed for 29 patients who underwent surgical ASD closure and 2 types of maze procedures (full and simplified maze procedures) for AF. The outcome related to the each procedure was examined. A Cox proportional hazards analysis was performed to assess the independent predictors of AF and atrial tachycardia (AT) recurrence...
September 3, 2018: Surgery Today
N Ma, J Mei, R X Lu, Z L Jiang, M Tang, F B Ding
Objective: To evaluate the efficacy of Mei mini maze procedure for treating atrial fibrillation (AF) patients with previously failed catheter ablation. Methods: Between August 2010 and May 2016, 48 AF (8 proximal AF, 15 persistent AF and 25 long-standing persistent AF) patients (29 males, 19 females, mean age: (62.5±7.3) years old) with previously 1-3 failed catheter ablation results were treated with Mei mini maze procedure in our department. Under thoracoscopic assistance, the procedure was performed through three ports on left chest wall, pulmonary vein isolation and ablations of the roof and posterior wall of left atrium was made by bipolar radiofrequency ablation...
August 24, 2018: Zhonghua Xin Xue Guan Bing za Zhi
James L Cox, Andrei Churyla, S Chris Malaisrie, Jane Kruse, Duc Thinh Pham, Olga N Kislitsina, Patrick M McCarthy
The initial surgical attempts to treat atrial fibrillation (AF) were isolation procedures designed to confine the arrhythmia to a specific area of the heart for relief of symptoms. The first surgical attempt to ablate AF was unsuccessful but was quickly followed by the Maze-I procedure on September 25, 1987. Because of several adverse sequelae of the Maze-I procedure, it was sequentially modified to the Maze-II and then Maze-III procedures. The Maze-IV procedure was introduced some 10 years later; these are the only 4 procedures that adhere to the concept of a maze pattern of lesions to ablate AF and leave both atria capable of being activated during normal sinus rhythm...
June 20, 2018: Canadian Journal of Cardiology
James L Cox, Andrei Churyla, S Chris Malaisrie, Duc Thinh Pham, Jane Kruse, Olga N Kislitsina, Patrick M McCarthy
BACKGROUND: Catheter ablation (CA) for long-standing persistent atrial fibrillation (LSPAF) is suboptimal and open surgical ablation, while more successful, is too invasive to be a first-line therapy. Less invasive hybrid procedures that combine thoracoscopic surgery (TS) with CA have been only marginally more successful for LSPAF than CA alone. METHODS: Joint hybrid procedures for LSPAF are based on the assumption that AF surgery and CA procedures can be guided by intraoperative mapping...
August 14, 2018: Annals of Thoracic Surgery
Charlotte van Laar, Niels J Verberkmoes, Hendrik W van Es, Thorsten Lewalter, Gan Dunnington, Stephen Stark, James Longoria, Frederik H Hofman, Carolyn M Pierce, Dipak Kotecha, Bart P van Putte
OBJECTIVES: This study sought to document the closure rate, safety, and stroke rate after thoracoscopic left atrial appendage (LAA) clipping. BACKGROUND: The LAA is the main source of stroke in patients with atrial fibrillation, and thoracoscopic clipping may provide a durable and safe closure technique. METHODS: The investigators studied consecutive patients undergoing clipping as part of a thoracoscopic maze procedure in 4 referral centers (the Netherlands and the United States) from 2012 to 2016...
July 2018: JACC. Clinical Electrophysiology
Fernando A Atik, Gustavo G Gomes, Fillipe F Rodrigues, Armindo Jreige, Wagner L Gali, Claudio R da Cunha, Alvaro V Sarabanda
OBJECTIVE: To determine whether cut and sew Cox maze III procedure is still associated with adequate safety endpoints when performed in conjunction with other open-heart procedures. METHODS: Between January 2008 and January 2015, 113 consecutive adult patients were submitted to cut and sew Cox maze III procedure in association with other operations for structural heart disease. Mean age was 49 years and 80 (70.8%) were females. Longstanding or persistent atrial fibrillation has occurred in 87...
August 8, 2018: Seminars in Thoracic and Cardiovascular Surgery
Petra Buttner, Roberta Galli, Daniela Husser, Andreas Bollmann
Atrial fibrillation, characterized by rapid disorganized electrical activation of myocardium, is caused by and accompanied by remodeling of myocardial tissue. We applied nonlinear optical microscopy (NLOM) to visualize typical myocardial features and atrial fibrillation effects in order to test anon-destructive imaging technology that in principle can be applied in vivo.Coherent anti-Stokes Raman scattering, endogenous two-photon excited fluorescence, and second harmonic generation were used to inspect unstained human atrial myocardium from three patients who underwent surgical Cox-MAZE procedure with amputation of left atrial appendage...
February 2018: Journal of Atrial Fibrillation
Camilla Skals Engelsgaard, Kenneth Bruun Pedersen, Lars Peter Riber, Peter Appel Pallesen, Axel Brandes
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and associated with increased risk of morbidity and mortality. AF surgery is widely used for rhythm control of AF, but previous studies have shown varying results. This study sought to investigate the long-term efficacy of concomitant maze IV (CMIV) surgery in an unselected AF population and identify predictors of late AF recurrence. Methods: In total 144 consecutive patients, who underwent CMIV between January 2006 and December 2010 were enrolled...
June 2018: IJC Heart & Vasculature
James L Cox, Niv Ad, Andrei Churyla, S Chris Malaisrie, Duc Thinh Pham, Jane Kruse, Olga Kislitsina, Patrick M McCarthy
BACKGROUND: There is concern that the right atrial lesions of the Maze procedure lead to more permanent pacemakers postoperatively and that they provide little therapeutic advantage over left atrial lesions alone. METHODS: A discussion of the pertinent anatomy related to atrial fibrillation and the performance of the Maze procedure, the potential ways that the specialized conduction system could theoretically be damaged by the procedure, non-procedure-related causes for increased postoperative pacemaker requirements, and the basis for the efficacy of the right atrial lesions of the Maze procedure are presented...
June 5, 2018: Annals of Thoracic Surgery
Michiko Watanabe, Hiroki Kohno, Yusuke Kondo, Hideki Ueda, Keiichi Ishida, Yusaku Tamura, Shinichiro Abe, Yasunori Sato, Yoshio Kobayashi, Goro Matsumiya
PURPOSE: Very few studies have investigated the efficacy of ganglionated plexus ablation during the conventional maze procedure. In this study, we sought to evaluate its additive effect in reducing recurrent atrial fibrillation after concomitant maze surgery. METHODS: A retrospective study was conducted of 79 patients who underwent Cox maze IV concomitantly with open-heart surgery with (GP group) or without (Maze group) ganglionated plexus mapping. All active ganglionated plexuses were ablated...
September 2018: Surgery Today
Hitomi Naruse, Noriyasu Kawada, Koichi Muramatsu, Hirokuni Naganuma, Kazuhiro Hashimoto
Generally, anticoagulation therapy is not essential for patients who maintain sinus rhythm after mitral valvuloplasty. A 66-year-old woman who had undergone mitral valvuloplasty and maze procedure for treatment of mitral valve regurgitation and atrial fibrillation 4 years ago was diagnosed as having left atrial thrombosis despite maintenance of sinus rhythm on electrocardiography. Echocardiography showed narrow mitral valvular area(1.5 cm2), loss of A wave and a huge left atrium. Repeat surgery was performed to replace the mitral valve and to remove the thrombus...
March 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Linda Sharples, Colin Everett, Jeshika Singh, Christine Mills, Tom Spyt, Yasir Abu-Omar, Simon Fynn, Benjamin Thorpe, Victoria Stoneman, Hester Goddard, Julia Fox-Rushby, Samer Nashef
BACKGROUND: Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. OBJECTIVES: To determine whether or not the maze procedure is safe, improves clinical and patient outcomes and is cost-effective for the NHS in patients with AF. DESIGN: Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised controlled trial...
April 2018: Health Technology Assessment: HTA
Samer A M Nashef, Simon Fynn, Yasir Abu-Omar, Tomasz J Spyt, Christine Mills, Colin C Everett, Julia Fox-Rushby, Jeshika Singh, Malcolm Dalrymple-Hay, Catherine Sudarshan, Massimiliano Codispoti, Peter Braidley, Francis C Wells, Linda D Sharples
OBJECTIVES: Atrial fibrillation (AF) reduces survival and quality of life (QoL). It can be treated at the time of major cardiac surgery using ablation procedures ranging from simple pulmonary vein isolation to a full maze procedure. The aim of this study is to evaluate the impact of adjunct AF surgery as currently performed on sinus rhythm (SR) restoration, survival, QoL and cost-effectiveness. METHODS: In a multicentre, Phase III, pragmatic, double-blinded, parallel-armed randomized controlled trial, 352 cardiac surgery patients with >3 months of documented AF were randomized to surgery with or without adjunct maze or similar AF ablation between 2009 and 2014...
October 1, 2018: European Journal of Cardio-thoracic Surgery
Grzegorz Suwalski, Piotr Suwalski
OBJECTIVES: Surgical ablation of atrial fibrillation (AF) aims to restore normal sinus rhythm while protecting the sinus node from surgical damage. Surgical lesions may affect autonomic neural structures and influence physiological heart rate variability (HRV). The primary aim of this study was to describe long-term dynamics of HRV after successful surgical ablation of AF. The secondary aim was to compare sinus node function after successful ablation of AF with either left atrial modified Maze procedure or epicardial pulmonary vein isolation after long-term follow-up...
October 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Shvetank Agarwal, Muhammad Salman Tahir Janjua, Paramvir Singh, Nadine Odo, Manuel R Castresana
A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology...
April 2018: Annals of Cardiac Anaesthesia
Vishal Shah, Oleg Orlov, Cinthia Orlov, Manabu Takebe, Matthew Thomas, Konstadinos Plestis
Atrial fibrillation is associated with increased morbidity and mortality in patients undergoing mitral valve surgery. There is a growing consensus that patients with preexisting atrial fibrillation should undergo surgical ablation at the time of mitral valve surgery. Novel surgical ablation techniques, including cryoablation, have been developed to facilitate concurrent minimally invasive procedures. This video tutorial describes a combined cryo-maze procedure and mitral valve repair through an upper ministernotomy in a patient with long-standing persistent atrial fibrillation and severe mitral regurgitation...
March 5, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Chia-Cheng Kuo, Hsiao-Huang Chang, Chung-Hsi Hsing, Hiong-Ping Hii, Nan-Chun Wu, Chin-Ming Hsu, Chun-I Chen, Bor-Chih Cheng
OBJECTIVES: Robotic mitral valve replacement (MVR) emerged in the late 1990s as an alternative approach to conventional sternotomy. With the increased use of bioprosthetic valves worldwide and strong patient desire for minimally invasive procedures, the safety and feasibility of robotic MVRs with bioprosthetic valves require investigation. METHODS: Between January 2013 and May 2017, 52 consecutive patients underwent robotic MVRs using the da Vinci Si surgical system (Intuitive Surgical Inc...
March 30, 2018: European Journal of Cardio-thoracic Surgery
Chawannuch Ruaengsri, Matthew R Schill, Ali J Khiabani, Richard B Schuessler, Spencer J Melby, Ralph J Damiano
Atrial fibrillation (AF) is the most common cardiac arrhythmia and the treatment options include medical treatment and catheter-based or surgical interventions. AF is a major cause of stroke, and its prevalence is increasing. The surgical treatment of AF has been revolutionized over the past 2 decades through surgical innovation and improvements in endoscopic imaging, ablation technology and surgical instrumentation. The Cox-maze (CM) procedure, which was developed by James Cox and introduced clinically in 1987, is a procedure in which multiple incisions are created in both the left and the right atria to eliminate AF while allowing the sinus impulse to reach the atrioventricular node...
April 1, 2018: European Journal of Cardio-thoracic Surgery
Cagdas Baran, Mustafa Serkan Durdu, Fatih Gumus, Mehmet Cakici, Mustafa Bahadir Inan, Mustafa Sirlak, Ahmet Ruchan Akar
OBJECTIVES: Sutureless aortic valve replacement (SU-AVR) is an alternative technique to standard aortic valve replacement. We evaluated our experience with the Perceval SU-AVR with concomitant mitral valve surgery, with or without tricuspid valve surgery, and aimed to discuss the technical considerations. METHODS: From January 2013 through June 2016, 30 patients with concomitant severe mitral valve disease, with or without tricuspid valve disease, underwent SU-AVR with the Perceval prosthesis in a single center...
June 2018: Journal of Thoracic and Cardiovascular Surgery
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