Surgical Outcomes of Cox-maze IV Procedure Using Bipolar Irrigated Radiofrequency Ablation and Cryothermy in Valvular Heart Disease

Abstract

BackgroundWe evaluated the efficacy of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in chronic atrial fibrillation associated with valvular heart disease.Material and MethodsFrom November 2005 to June 2009, ninety four patients have undergone valvular heart surgery with Cox-maze IV procedure. Preoperative duration of atrial fibrillation was 7.6±6.5 years and follow-up duration was 22.7±12.3 months.ResultsThere were two (2.1%) postoperative deaths not related to maze procedure. Two cerebrovascular accidents, five low cardiac output syndromes and two permanent pacemaker implantations have occurred after surgery. Preoperative ejection fraction on echocardiography was 55.3±8.1% and ejection fraction of postoperative six month was 54.7±6.5%. Left atrial size of preoperative and postoperative were 61.5±11.6 mm and 53.1±8.4 mm at each. Freedom from atrial fibrillation rate at postoperative six-month was 80.7% and the cases of recurrence of atrial fibrillation after six months were three (3.3%). Risk factors for failure or recurrence of maze procedure were old age (p=.010) and preoperative moderate or severe tricuspid regurgitation (p=.033).ConclusionThe Cox-maze IV procedure using RFBP2 and cryothermy is quite safe and freedom from atrial fibrillation at postoperative 6 month was 82.5%. Risk factors for failure or recurrence of atrial fibrillation after Cox-maze IV were old age and preoperative over moderate tricuspid regurgitation.

Predictive Factors of Sustained Sinus Rhythm and Recurrent Atrial Fibrillation after the Maze Procedure

“…In our study, age, duration of AF, and postoperative LA dimension were identified as risk factors for early conversion (at postoperative 6 months), but not for sustained SR during the mid-term follow-up period. The risk factors for early conversion (at postoperative 6 months) were also described in a previous report [17]. …”

“…Although the LA dimension and age were not predictive factors of recurrent AF in the mid-term follow-up, they were significant predictors of early SR conversion. Previous reports [17,18] have demonstrated that age is an important factor for SR conversion after the maze operation in patients with giant LA and a more aggressive surgical approach is required in younger patients with giant LA for more favorable results. Many reports [17,19] readily ruled the maze procedure a success or failure at the postoperative 3rd month or 6th month, but many cases for which operative success had been determined then experienced delayed recurrence of AF [19].…”

The methods of treatment of atrial fibrillation in patients with valvular heart disease

“…Kim та співавт. з тривалістю спостереження 10 років взяли участь 540 пацієнтів, які перенесли хірургічну корекцію мітральної вади (пластика або протезування) [16]. У частини пацієнтів проводили хірургічну абляцію ФП із застосуванням холодової (n = 185) та мікрохвильової енергії (n = 10).…”

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

“…In addition, age is deemed to be an independent predictor of stroke in patients with AF [9]. Age of≥70 years is frequently accompanied by multiple comorbidities, and is a significant risk factor associated with worse postoperative results [10][11][12][13]. Thus, whether concomitant BRFA should be performed in elderly patients is controversial.…”