Impact of the Cox-Maze IV Procedure on Left Atrial Mechanical Function

Brennan, A.; Martin, William G.; Adams, Heath; Yii, Michael

doi:10.1016/j.hlc.2018.11.008

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…The effectiveness of the Maze procedure for treating AF is well established, and this procedure is currently the gold standard of surgical ablation [ 6 ]. These factors along with the increased incidence of AF may have contributed to the increased use of the Maze procedure in Taiwan, similar to worldwide trends [ 1 , 29 ]. The slight trend of Maze procedures toward lower-volume hospitals observed in Taiwan may be due to the increased willingness of low-volume physicians to perform concurrent surgical ablation of AF based on the clinical benefits and advanced modern practices described above.…”

Section: Discussionmentioning

confidence: 99%

Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study

Chang

Huang

et al. 2023

BMC Cardiovasc Disord

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Background Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has been documented with favorable outcomes of various cardiac procedures such as mitral valve surgery and aortic valve replacement. We aimed to determine the volume–outcome relationship (i.e., association between surgical volume and outcomes) for the concomitant Maze procedure during major cardiac surgeries. Methods This nationwide population-based cohort study retrieved data from the Taiwan National Health Insurance Research Database. Adult patients undergoing concomitant Maze procedures during 2010–2017 were identified; consequently, 2666 patients were classified into four subgroups based on hospital cumulative surgery volumes. In-hospital outcomes and late outcomes during follow-up were analyzed. Logistic regression and Cox proportional hazards model were used to analyze the volume–outcome relationship. Results Patients undergoing Maze procedures at lower-volume hospitals tended to be frailer and had higher comorbidity scores. Patients in the highest-volume hospitals had a lower risk of in-hospital mortality than those in the lowest-volume hospitals [adjusted odds ratio, 0.30; 95% confidence interval (CI), 0.15–0.61; P < 0.001]. Patients in the highest-volume hospitals had lower rates of late mortality than those in the lowest-volume hospitals, including all-cause mortality [adjusted hazard ratio (aHR) 0.53; 95% CI 0.40–0.68; P < 0.001] and all-cause mortality after discharge (aHR 0.60; 95% CI 0.44–0.80; P < 0.001). Conclusions A positive hospital volume–outcome relationship for concomitant Maze procedures was demonstrated for in-hospital and late follow-up mortality. The consequence may be attributed to physician skill/experience, experienced multidisciplinary teams, and comprehensive care processes. We suggest referring patients with frailty or those requiring complicated cardiac surgeries to high-volume hospitals to improve clinical outcomes. Trial registration: the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502).

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Section: Discussionmentioning

confidence: 99%

Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study

Chang

Huang

et al. 2023

BMC Cardiovasc Disord

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“…The relevant literature has shown that the rheumatic valve procedure can correct organic valve pathology, restore patients’ hemodynamics, reduce cardiac load, and significantly improve cardiac function ( 28 , 29 ). It has been found that the Cox-Maze procedure can help restore the contractile function of the left atrium, reduce the load on the left atrium, avoid further dilatation of the left atrium, and improve the patient's cardiac function while reversing SR ( 30 ). This study also found that the postoperative LVEF of both groups did not improve much at the time of discharge from the hospital compared with the preoperative period, and it has been shown that the early postoperative LVEF after the rheumatic valve procedure concomitant with Cox-Maze IV procedure does not improve significantly compared with the preoperative period, and even decreases 10%, which may be a result of the combination of several factors: (1) preoperative valve disease leads to long-term overload of the left ventricle, myocardial persistent damage, and contractile function being severely impaired; (2) early postoperative cardiomyocyte edema, which affects myocardial fibers to regulate themselves abnormally, the myocardial contractile force is not fully restored to reach the optimal initial length, and left ventricular ejection volume may even be reduced ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

Zhang,

Hou,

Mei

et al. 2024

Front. Cardiovasc. Med.

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BackgroundCurrently, the bipolar radiofrequency ablation forceps manufactured by AtriCure are the main instrument for surgical ablation in patients with rheumatic heart disease (RHD) concomitant with atrial fibrillation (AF). The bipolar radiofrequency ablation forceps by Med-Zenith has a greater advantage in price compared with AtriCure. However, few studies have been reported on the comparison of their clinical efficacy. The aim of this study is to compare the short-term clinical efficacy of the two ablation forceps for RHD concomitant with AF.MethodsClinical data of 167 patients with RHD concomitant with AF admitted to the Department of Cardiac Major Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, were retrospectively analyzed, and the restoration efficacy of sinus rhythm (SR) and cardiac function after surgery were compared with two ablation forceps.ResultsThe end-systolic diameter of the right atrium and the end-systolic diameter of the left atrium in the patients of both groups at each postoperative time point decreased compared with that of the preoperative period (P < 0.05), and the left ventricular ejection fraction started to improve significantly at 6 months after surgery compared with that of the preoperative period (P < 0.05). There was no difference between the two groups of patients in the comparison of the aforementioned indicators at different points in time (P > 0.05). At 12 months postoperatively, the SR maintenance rate in using the ablation forceps by Med-Zenith (73.3%) was lower than that for AtriCure (86.4%) and the cumulative recurrence rate of AF in using the Med-Zenith ablation forceps was greater than that for AtriCure.ConclusionsThe two bipolar radiofrequency ablation forceps compared in the study are safe and effective in treating patients of RHD concomitant with AF, and the ablation forceps by AtriCure may be more effective in restoring SR in the short term.

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The occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation

Wang

Gao

Deng

et al. 2021

J Cardiothorac Surg

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Objective To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation. Methods All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model. Results We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127–1.874), area under ROC curve was 0.81, the Jordan index was 0.665. Conclusion The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.

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Impact of the Cox-Maze IV Procedure on Left Atrial Mechanical Function

Cited by 4 publications

References 18 publications

Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study

Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

The occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation

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