Left Atrial Reduction Enhances Outcomes of Modified Maze Procedure for Permanent Atrial Fibrillation During Concomitant Mitral Surgery

• Published in: The Annals of thoracic surgery Vol. 82; no. 5; pp. 1758 - 1764
• Main Authors: Badhwar, Vinay, Rovin, Joshua D., Davenport, Gail, Pruitt, J. Crayton, Lazzara, Robert R., Ebra, George, Dworkin, Gary H.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2006
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Cardiac Surgical Procedures; Catheter Ablation; Female; Heart Atria - surgery; Heart Diseases - complications; Heart Diseases - surgery; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve - surgery; Treatment Outcome; 24; 35
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.05.044

Success of the maze procedure after mitral operations with large left atria and permanent atrial fibrillation remains suboptimal. Current technique variations tend to obscure the decision-making algorithm in these patients. A single energy-source approach for the surgical management of patients with large left atria and permanent atrial fibrillation is presented. From January 2003 to July 2005, 71 consecutive drug-resistant patients with permanent atrial fibrillation and left atrial enlargement who required mitral valve surgery underwent aggressive left atrial reduction combined with left-sided only irrigated radiofrequency unipolar maze. Left atrial dimensions were measured by transesophageal echo anterior-to-posterior leading edge-to-edge standardized protocol. There were 39 men (54.9%) and 32 women (45.1%), and their mean age was 71.9 ± 9.5 years. Mean duration of atrial fibrillation was 49.3 ± 58.0 months. All patients underwent left atrial reduction with identical Cox-maze III pulmonary vein and appendage isolation including mitral annular connection, followed by appendage suture closure. Left atrial size was reduced from 6.7 ± 1.2 cm to 4.3 ± 0.6 cm ( p = 0.001). Mitral valve repair was performed in 55 patients (76.1%) and replacement in 17 (23.9%). The 30-day mortality was 4.2% (3/71). Postoperative length of stay was 8.8 ± 5.7 days, with 56 (82.4%) of 68 patients discharged in normal sinus rhythm. P-wave sinus rhythm was 93.8% between 7 and 12 months and 92.0% for patients with 1 year or more of follow-up. Left atrial reduction combined with a left atrial only single energy-source radiofrequency maze procedure is an effective treatment for patients with permanent atrial fibrillation undergoing concomitant mitral operations.