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Cox Maze IV

Zhaolei Jiang, Min Tang, Nan Ma, Hao Liu, Fangbao Ding, Chunrong Bao, Ju Mei
Cox-maze IV ablation by bipolar radiofrequency clamp was considered to be only performed through median sternotomy (MS), but impossible through right minithoracotomy (RM). Now, we developed a novel technique of performing Cox-maze IV ablation entirely by bipolar clamp through RM. To compare the outcomes of RM or MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. All 152 patients underwent mitral valve surgery and concomitant Cox-maze IV ablation with bipolar clamp through RM (n = 69) or MS (n = 83) were analyzed for outcome differences...
February 2, 2018: Heart and Vessels
Takashi Murashita, J Scott Rankin, Lawrence M Wei, Harold G Roberts, Mohamad A Alkhouli, Vinay Badhwar
OBJECTIVES: Oral anticoagulants have inherent risks. In the absence of clear evidence, anticoagulant use after surgical ablation for atrial fibrillation remains variable. This study examined patient outcomes with and without oral anticoagulants after successful surgical ablation. METHODS: From October 2011 to April 2016, 239 consecutive patients underwent biatrial Cox Maze IV operations for persistent atrial fibrillation. All patients received endocardial left atrial appendage obliteration...
December 6, 2017: Journal of Thoracic and Cardiovascular Surgery
Naoki Masaki, Shunsuke Kawamoto, Naotaka Motoyoshi, Osamu Adachi, Kiichiro Kumagai, Satoshi Kawatsu, Yukihiro Hayatsu, Shintaro Katahira, Katsuhiro Hosoyama, Masatoshi Akiyama, Yoshikatsu Saiki
PURPOSE: The Cox maze IV (CMIV) procedure is being used increasingly frequently for surgical ablation of atrial fibrillation (AF). This study aimed to identify the risk factors of the need for postoperative pacemaker implantation (PMI) after CMIV. METHODS: Preoperative, intraoperative, and postoperative data were retrospectively collected from 67 consecutive patients who underwent CMIV at our institution; 7 (10.4%) required PMI (as a treatment of brady AF or sick sinus syndrome)...
December 16, 2017: Surgery Today
Niv Ad, Sari D Holmes, Ted Friehling
BACKGROUND: Rhythm control is challenging in patients with extended atrial fibrillation (AF) duration and persistent/long-standing persistent AF. Among surgical approaches to treat AF, the Cox maze procedure performed using alternative energy sources remains superior to other beating heart techniques. We examined permanence of safety and success for the on-pump, minimally invasive, stand-alone Cox maze procedure 5 years after surgery. METHODS AND RESULTS: Stand-alone, right 5 cm minithoracotomy, Cox maze III/IV procedure for nonparoxysmal AF was conducted in 133 patients (mean follow-up=65±34 months)...
November 2017: Circulation. Arrhythmia and Electrophysiology
G Hossein Almassi
No abstract text is available yet for this article.
October 5, 2017: Journal of Thoracic and Cardiovascular Surgery
Farah N Musharbash, Matthew R Schill, Laurie A Sinn, Richard B Schuessler, Hersh S Maniar, Marc R Moon, Spencer J Melby, Ralph J Damiano
OBJECTIVE: Atrial fibrillation (AF) is associated with an increased mortality risk. The Cox-maze IV procedure (CM4) performed concomitantly with other cardiac procedures has been shown to be effective for restoring sinus rhythm. However, few data have been published on the late survival of patients undergoing a concomitant CM4. METHODS: Patients undergoing cardiac surgery were retrospectively reviewed from 2001 to 2016 (n = 10,859). Patients were stratified into 3 groups: patients with a history of AF receiving a concomitant CM4 (CM4; n = 438), patients with a history of AF unaddressed during surgery (Untreated AF; n = 1510), and patients without AF history (No AF; n = 8911)...
January 2018: Journal of Thoracic and Cardiovascular Surgery
Alexander V Bogachev-Prokophiev, Alexander V Afanasyev, Sergei I Zheleznev, Alexei N Pivkin, Michael S Fomenko, Ravil M Sharifulin, Alexander M Karaskov
OBJECTIVE: The appearance of atrial fibrillation is associated with significant clinical deterioration in patients with obstructive hypertrophic cardiomyopathy; therefore, maintenance of sinus rhythm is desirable. Guidelines and most articles have reported the results of catheter ablation and pharmacologic atrial fibrillation treatment; nevertheless, data regarding concomitant procedures during septal myectomy are limited. The aim of this study was to assess the outcomes of concomitant atrial fibrillation treatment in patients with obstructive hypertrophic cardiomyopathy...
September 1, 2017: Journal of Thoracic and Cardiovascular Surgery
Hailong Cao, Yunxing Xue, Qing Zhou, Minggang Yu, Chenbin Tang, Dongjin Wang
BACKGROUND: Atrial fibrillation (AF) adversely affects surgical outcomes of cardiac valve surgery. Surgical ablation is an effective way to treat valvular AF. The aim of this study was to evaluate the late outcome of surgical radiofrequency ablation and explore the risk factors of AF recurrence in Chinese patients undergoing cardiac valve surgery. METHODS: Three hundred ninety six consecutive patients with persistent valvular AF were enrolled in this study. They underwent concomitant modified Maze IV and were completed follow-ups...
August 3, 2017: Journal of Cardiothoracic Surgery
Jonathan E Labin, Nowrin Haque, Laurie A Sinn, Richard B Schuessler, Marc R Moon, Hersh S Maniar, Spencer J Melby, Ralph J Damiano
OBJECTIVE: To determine whether the etiology of mitral valve disease (MVD), due to either rheumatic or degenerative pathology, influences long-term outcomes after the Cox-Maze IV procedure (CMPIV). METHODS: Between February 2001 and July 2015, 245 patients received a CMIV and concomitant mitral valve procedure. Patients were separated into 2 cohorts based on their etiology of MVD, degenerative (n = 153) and rheumatic (n = 92). Patients were followed prospectively (mean follow-up: 41 ± 37 months) for recurrent atrial tachyarrhythmias (ATAs)...
September 2017: Journal of Thoracic and Cardiovascular Surgery
Matthew R Schill, Laurie A Sinn, Jason W Greenberg, Matthew C Henn, Timothy S Lancaster, Richard B Schuessler, Hersh S Maniar, Ralph J Damiano
OBJECTIVE: The Cox-Maze IV procedure has been shown to be an effective treatment for atrial fibrillation when performed concomitantly with other operations either via median sternotomy or right minithoracotomy. Few studies have compared these approaches in patients with lone atrial fibrillation. This study examined outcomes with sternotomy versus minithoracotomy in stand-alone Cox-Maze IV procedures at our institution. METHODS: Between 2002 and 2015, 195 patients underwent stand-alone biatrial Cox-Maze IV...
May 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Kasra Shaikhrezai, Cristiano Spadaccio, Steven Hunter
We introduce a maneuver to perform the box lesion as a part of Cox maze IV procedure with single radiofrequency clamp. The maneuver entails engaging the right pulmonary veins with the clamp, then advancing the clamp jaws underneath the superior vena cava through the transverse sinus to include the roof and the left pulmonary veins in the clamp. We regularly use this technique for box lesion with desirable transmurality.
April 12, 2017: Thoracic and Cardiovascular Surgeon
Matthew R Schill, Farah N Musharbash, Vivek Hansalia, Jason W Greenberg, Spencer J Melby, Hersh S Maniar, Laurie A Sinn, Richard B Schuessler, Marc R Moon, Ralph J Damiano
OBJECTIVE: Most patients with atrial fibrillation (AF) undergoing cardiac surgery do not receive concomitant ablation. This study reviewed outcomes of patients with AF undergoing Cox-maze IV (CMIV) procedure with radiofrequency and cryoablation and coronary artery bypass grafting (CABG) at our institution. METHODS: Between the introduction of radiofrequency ablation in 2002 and 2015, 135 patients underwent left- or biatrial CMIV with CABG. Patients undergoing other cardiac procedures, except mitral valve repair, or who had emergent, reoperative, or off-pump procedures were excluded...
May 2017: Journal of Thoracic and Cardiovascular Surgery
Vinay Badhwar, J Scott Rankin, Ralph J Damiano, A Marc Gillinov, Faisal G Bakaeen, James R Edgerton, Jonathan M Philpott, Patrick M McCarthy, Steven F Bolling, Harold G Roberts, Vinod H Thourani, Rakesh M Suri, Richard J Shemin, Scott Firestone, Niv Ad
Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm...
January 2017: Annals of Thoracic Surgery
Joshua Xu, Jessica G Y Luc, Kevin Phan
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF...
September 2016: Journal of Thoracic Disease
Charlotte van Laar, Johannes Kelder, Bart P van Putte
The purpose of this study was to update the current evidence regarding the efficacy and safety of the totally thoracoscopic maze (TT-maze) procedure for the treatment of atrial fibrillation (AF). Fourteen studies published between 2011 and 2016 and comprising 1171 patients were included as follows: 545 (46%) patients had paroxysmal AF (pAF), 268 (23%) persistent AF (persAF) and 358 (31%) longstanding persistent AF (LSPAF). Fixed- and random-effect models were used to calculate the pooled overall freedom from atrial arrhythmias...
January 2017: Interactive Cardiovascular and Thoracic Surgery
Jun Shi, Zhi-Xuan Bai, Ben-Gui Zhang, Wen-Jun Ren, Ying-Qiang Guo
OBJECTIVES: To determine the effectiveness of a simplified surgical treatment method for atrial fibrillation (AF). METHODS: Between September 2012 and October 2013, 120 patients (mean age, 52.3 ± 8.8 years) underwent valve surgery and concomitant bipolar radiofrequency ablation for the treatment of AF. Patients were randomized to a Cox maze IV procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group (n = 60). Freedom from AF was defined as freedom from any left atrial arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after 6 months...
December 2016: Interactive Cardiovascular and Thoracic Surgery
Gabriella Boano, Meriam Åström Aneq, Jennie Kemppi, Farkas Vánky
OBJECTIVE: The indications for and the risk and benefit of concomitant surgical ablation for atrial fibrillation (AF) have not been fully delineated. Our aim was to survey whether the Cox-maze IV procedure is associated with postoperative heart failure (PHF) or other adverse short-term outcomes after mitral valve surgery (MVS). DESIGN: Consecutive patients with AF undergoing MVS with (n = 50) or without (n = 66) concomitant Cox-maze IV cryoablation were analysed regarding perioperative data and one-year mortality...
February 2017: Scandinavian Cardiovascular Journal: SCJ
Zhaolei Jiang, Nan Ma, Hao Liu, Min Tang, Fangbao Ding, Chunrong Bao, Ju Mei
Isolated aortic valve diseases can lead to atrial fibrillation (AF) by causing left atrium pressure overload and enlargement. At present, most patients with preoperative AF and isolated aortic valve disease have undergone a Cox-maze IV procedure through a left atriotomy under cardiopulmonary bypass with aortic cross-clamping. Here, we describe a novel modified epicardial radiofrequency ablation procedure performed on a beating heart without aortic cross-clamping or opening the left atrium. This technique has proved to be safe and feasible, with good clinical outcomes...
June 2016: Annals of Thoracic Surgery
Ovidio A García-Villarreal
AIM: To compare the efectiveness of the cut-and-sew Cox-maze III procedure against the Cox-maze IV peocedure by means of intraoperative bipolar radiofrequency delivery clamp. MATERIAL: From January 2011 to October 2014, 50 patients were operated on with surgery for atrial fibrillation. All cases underwent mitral valve surgery as the first procedure, and secondarily a surgical procedure for atrial fibrillation was also performed. There were 2 groups. Group I (Cox-maze III «cut-and-sew»), and Group II (Cox-maze IV, intraoperative bipolar radiofrequency ablation)...
July 2016: Archivos de Cardiología de México
Sheng-Tzung Tsai, Li-Jin Chen, Yueh-Jan Wang, Shin-Yuan Chen, Guo-Fang Tseng
BACKGROUND/AIMS: Rostral intralaminar thalamic nucleus (ILN) has been shown to modulate cognition through indirect connection with the hippocampus and prefrontal cortex. We explored the effects of deep brain stimulation (DBS) to the rostral ILN on spatial memory acquisition, brain neuronal activation and cortical and hippocampal synaptic changes in rats. METHODS: The Morris water maze (MWM) task was used to evaluate the spatial memory of the rats. The expression of c-fos, an immediate early gene, was used to identify neural activation in the cerebral cortex and hippocampus...
2016: Stereotactic and Functional Neurosurgery
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