Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting

Schill, Matthew R.; Musharbash, Farah N.; Hansalia, Vivek; Greenberg, Jason W.; Melby, Spencer J.; Maniar, Hersh S.; Sinn, Laurie A.; Schuessler, Richard B.; Moon, Marc R.; Damiano, Ralph J.

doi:10.1016/j.jtcvs.2016.12.034

Cited by 23 publications

(19 citation statements)

References 15 publications

(22 reference statements)

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“…216 potentially relevant full-text articles were reviewed and finally, 24 were included for analysis. Of the 24 included studies, 12 of them were dedicated to reporting the surgical treatment of AF in patients undergoing CABG (16, 20, 22–33). Data about CABG patients were extracted from the subgroup analysis of the remaining 12 studies, which were principally reported concomitant cardiac surgery outcomes (34–46).…”

Section: Resultsmentioning

confidence: 99%

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Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

Khiabani

Adademir

Schuessler

et al. 2018

Innovations�(Phila)

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Untreated atrial fibrillation is associated with an increased risk of all-cause mortality and morbidity. Despite the current guidelines recommending surgical ablation of atrial fibrillation at the time of coronary artery bypass surgery, most patients with concomitant atrial fibrillation and coronary artery disease do not receive surgical ablation for their atrial fibrillation. This review reports the efficacy of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass. PubMed was systematically searched for studies reporting outcomes of concomitant surgical ablation in coronary artery bypass patients between January 2002 and March 2018. Data were independently extracted and analyzed by two investigators. Twenty-four studies were included. Twelve studies exclusively reported outcomes of surgical ablation in patients undergoing coronary artery bypass, whereas the remaining 12 reported outcomes of concomitant cardiac surgery with subgroup analysis. Only four studies performed the concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze procedure, whereas lesser lesion sets had more variable outcomes, ranging from 35% to 93%. In most studies, the addition of surgical ablation was not associated with increased morbidity and mortality. Although the Cox-Maze procedure had the greatest short- and long-term success rates, most studies comprising the evidence documenting the safety and efficacy of adding surgical ablation were of low or moderate quality. There was a great deal of heterogeneity among study populations, follow-up times, methods, and definition of failure. To establish a consensus regarding a surgical ablation technique for atrial fibrillation in coronary artery bypass population, larger multicenter randomized controlled studies need to be designed.

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Section: Resultsmentioning

confidence: 99%

“…However, the CMP-IV has had significantly shorter operative times and lower complication rates (19). More recently, Schill et al reported a single institution outcome of concomitant CMPIV and CABG with 98% freedom from atrial tachyarrhythmias at 1 year, with 88% off antiarrhythmic drugs (20).…”

Section: Introductionmentioning

confidence: 99%

Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

Khiabani

Adademir

Schuessler

et al. 2018

Innovations�(Phila)

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“…Discrepancies between reviewers were resolved by group discussion. At this stage, 7392 articles were excluded because they did not match study criteria while 37 articles were reviewed at full‐text level. The references of these articles were screened and 8 more articles were identified reaching 45 articles assessed at full‐text level: of these, 17 were excluded for the following reasons: (a) despite reporting the use of BA and LA approaches in 8 studies there was no clear separation of at least one outcome for the two groups, only one type (BA or LA) of ablation approach reported for 6 studies, patients populations overlapping with studies already included for 3 studies, leaving in total 28 studies suitable to be included in this meta‐analysis …”

Section: Methodsmentioning

confidence: 99%

“…(a) despite reporting the use of BA and LA approaches in 8 studies there was no clear separation of at least one outcome for the two groups, [6][7][8]11,18,[41][42][43] only one type (BA or LA) of ablation approach reported for 6 studies, 9,[12][13][14][15][16] patients populations overlapping with studies already included for 3 studies, 10,17,40 leaving in total 28 studies suitable to be included in this meta-analysis. [3][4][5][44][45][46][47] 2.2 | Data extraction, selected outcomes, and subgroup analysis Data were extracted from each study by the three reviewers from the text, tables, and figures.…”

Section: )mentioning

confidence: 99%

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Cappabianca

Ferrarese

Tutino

et al. 2019

Cardiovasc electrophysiol

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Introduction The latest STS guidelines recommend concomitant atrial fibrillation (AF) ablation not only during mitral surgery (Class IA) but also during other‐than‐mitral cardiac surgery procedures (Class IB) in patients with preoperative AF. Conventional Cox‐Maze III/IV procedures are performed on both atria (BA), but several studies reported excellent results with left atrial only (LA) ablations: the scope of this study is to compare the safety and efficacy of BA vs LA approach. Methods and Results Pubmed, Scopus, and WOS were searched from inception to November 2018: 28 studies including 7065 patients and comparing the performance of BA vs LA approaches were identified: of these, 16 (57.1%) enrolled exclusively patients with non‐paroxysmal AF forms, 10 (35.7%) focused on mitral surgery as main procedure, and 16 (57.1%) regarded patients undergone Cox‐Maze with radiofrequency. The 6‐ and 12‐months prevalence of sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09‐1.73, P = .008 and OR, 1.37, CI, 0.99‐1.88, P = .05 respectively). Permanent pacemaker (PPM) implantation (OR, 1.85, CI, 1.38‐2.49, P < .0001) and reopening for bleeding (OR, 1.70, CI, 1.05‐2.75, P = .03) were higher in the BA group. Among patients undergone PPM implantation, BA group had a significantly higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49‐6.07, P = .002). Conclusions Concomitant BA ablation appears superior to LA ablation in terms of efficacy but is associated with a higher risk of bleeding and of PPM implantation, more frequently due to sinoatrial node dysfunction. LA approach should be preferable in patients with a higher risk of bleeding or with perioperative risk factors for PPM implantation.

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“…Модифицированные методики данной операции в целом не увеличивают операционный риск и частоту серьезных осложнений, но удлиняют время операции, ишемии миокарда и частоту имплантации ЭКС. Пациенты демонстрируют сохранение синусового ритма в 94-96%, сходную выживаемость при лучшем качестве жизни по сравнению с таковыми без проведения коррекции нарушений ритма [23][24][25]. Однако целесообразность повсеместного выполнения данной операции у больных с ИБС именно для профилактики ПОФП вызывает справедливые сомнения вследствие возможного усложнения оперативного вмешательства.…”

Section: характеристика послеоперационного периодаunclassified

Comparative Effectiveness of Radiofrequency Pulmonary Vein Isolation Plus Amiodarone Therapy in Preventing Post-Coronary Artery Bypass Grafting Atrial Fibrillation

Ревишвили¹,

Попов²,

Плотников³

et al. 2020

Vestnik aritmologii

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Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

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Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting

Cited by 23 publications

References 15 publications

Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Comparative Effectiveness of Radiofrequency Pulmonary Vein Isolation Plus Amiodarone Therapy in Preventing Post-Coronary Artery Bypass Grafting Atrial Fibrillation

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