Normal Quality of Life after the Cox-Maze Procedure for Atrial Fibrillation

Melby, Spencer J.; Zierer, Andreas; Lubahn, Jordon G.; Bailey, Marci S.; Cox, James L.; Schuessler, Richard B.; Damiano, Ralph J.

doi:10.1097/imi.0b013e31819165d7

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…While the majority of patients underwent their procedures through a median sternotomy, 29 patients had a less-invasive right minithoracotomy approach. These patients had an identical lesion set, that has been previously described 7. However, the left atrial appendage was oversewn from the endocardial surface instead of being amputated.…”

Section: Methodsmentioning

confidence: 97%

The Cox maze IV procedure: Predictors of late recurrence

Damiano

Schwartz

Bailey

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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215

172

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Objectives The Cox-Maze III procedure(CMP) achieved high cure rates and became the surgical gold standard for the treatment of atrial fibrillation(AF). Due to its invasiveness, a more simplified ablation-assisted procedure(CMP-IV) has been performed at our institution since January, 2002. The study examined multiple preoperative and perioperative variables to determine predictors of late recurrence. Methods Data were collected prospectively on 282 patients who underwent the CMP-IV from January 2002 through December 2009. Forty-two percent of patients had paroxysmal and 58% had either persistent or long-standing persistent AF. All patients were available for follow-up. Follow-up included ECGs in all patients. Since 2006, 24 hour holter monitoring was obtained in 94% of patients at 3, 6 and 12 months. Data were analyzed by logistic regression analysis at 12 months with 13 preoperative and perioperative variables used as co-variants. Results Sixty-six percent of patients had a concomitant procedure. Following an ablation-assisted CMP, the freedom from AF was 89%, 93%, and 89% at 3, 6, and 12 months, respectively. The freedom from both AF and antiarrhythmic drugs was 63%, 79%, and 78% at 3, 6, and 12 months. The risk factors for AF recurrence at one year were enlarged left atrial(LA) diameter(p=0.027), failure to isolate the entire posterior left atrium(p=0.022), and early atrial tachyarrhythmias (ATAs)(p=0.010). Conclusions The CMP-IV has a high success rate at one year, even with improved follow-up and stricter definitions of failure. In patients with large LA, there may be a need for more extensive size reduction or expanded lesion sets.

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Section: Methodsmentioning

confidence: 97%

The Cox maze IV procedure: Predictors of late recurrence

Damiano

Schwartz

Bailey

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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215

172

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“…Minimizing the need for atrial incisions has shortened myocardial ischemic and cardiopulmonary bypass times for the CMIV and allowed us to perform AF operations more safely in patients with more comorbidities than previously seen in earlier CM series [4]. The increased risks found with a concomitant CMIV procedure are offset not only by a realistic expectation for the elimination of AF, a leading cause of early and late morbidity and death in patients undergoing mitral operations, but also by an improved quality of life after successful AF interventions [25, 26]. …”

Section: Commentmentioning

confidence: 99%

Cox-Maze IV Results for Patients With Lone Atrial Fibrillation Versus Concomitant Mitral Disease

Saint¹,

Bailey²,

Prasad³

et al. 2012

The Annals of Thoracic Surgery

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Background This study compared Cox-Maze IV (CMIV) outcomes for the treatment of atrial fibrillation (AF) in patients with lone AF vs those with AF and mitral valve (MV) disease. Methods Since 2002, 200 patients have undergone a CMIV procedure for lone AF (n = 101) or concomitantly with MV operations (n = 99). Preoperative, perioperative, and late outcomes between these groups were compared. Data were collected prospectively and reported at 3, 6, and 12 months. Results Lone AF patients had AF of longer duration; patients with AF and MV disease were older, with larger left atria and worse New York Heart Association classification (p < 0.05). Operative mortality (1% vs 4%, p > 0.05, respectively) was similar between both groups. Perioperative atrial tachyarrhythmias were more prevalent in patients with concomitant MV operations (57% vs 41%, p = 0.03); however, freedom from AF and antiar-rhythmics was similar for both groups at 12 months (76% and 77%). The only predictor for atrial tachyarrhythmia recurrence or arrhythmic drug dependence was failure to isolate the posterior left atrium (p < 0.01). Conclusions Patients with AF and MV disease have distinct comorbidities compared with patients with lone AF. However, the CMIV is safe and effective in both groups and should be considered for patients with AF undergoing MV operations. Patients with MV disease had more atrial tachyarrhythmias at 3 months, but freedom from AF and antiarrhythmics was similar to patients with lone AF at 1 year. The posterior left atrium should be isolated in every patient, because this was the only predictor for failure of the CMIV for either group.

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“…Таким образом, уровень КЖ у дaннoй когорты пациентов статистически не отличался от уров-ня КЖ условно здоровых людей [44].…”

Section: хирургическое лEчение фибPилляции предсердийunclassified