Modification of the Cox-Maze Procedure for Atrial Fibrillation with Large Left Atrium: Development of Surgical Technique to Increase the Left Atrial Contractility.
- Author:
Chang Hyun KANG
1
;
Ki Bong KIM
;
Dae Won SON
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine.
- Publication Type:Original Article
- Keywords:
Atrial fibrillation;
Arrhythmia Surgery;
Surgery method
- MeSH:
Atrial Fibrillation*;
Echocardiography;
Follow-Up Studies;
Heart Atria*;
Heart Valve Diseases;
Humans;
Pulmonary Veins;
Veins
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1999;32(3):249-254
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. MATERIAL AND METHOD: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). RESULT: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). CONCLUSION: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.
