Biatrial Cox Maze <b>Ⅳ</b> cryoablation procedure combined with minimally invasive mitral valve surgery for concomitant atrial fibrillation _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MEI Ju ,  JIANG Zhaolei , TANG Min , MA Nan , LIU Hao , YIN Hang , HE Yi

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Atrial fibrillation; mitral valve; cryoablation; minimally invasive surgery

DOI：

10.7507/1007-4848.201605026

Video：

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Objective To evaluate the safety and efficacy of biatrial Cox Maze Ⅳ cryoablation for concomitant atrial fibrillation (AF) during minimally invasive valve surgery. Methods A total of 47 patients (26 males, 21 females, age of 42-69 years) with mitral valve disease and long-standing persistent AF received minimally invasive biatrial Cox Maze Ⅳ cryoablation procedure combined with mitral valve surgery through right minithoracotomy from January 2014 to September 2015. The etiology of mitral valve disease was rheumatic (n=31) and degenerative (n=16). AF duration ranged from 2 to 11 years. Diameter of the left atrium ranged from 43 to 60 mm. Concomitant biatrial Cox Maze Ⅳ cryoablation procedure was performed through right lateral minithoracotomy. Results All 47 patients successfully underwent this minimally invasive concomitant biatrial Cox Maze Ⅳ cryoablation procedure and valve surgery. No patient needed conversion to sternotomy during the surgery. The mean cardiopulmonary bypass time, aortic cross-clamp time and cryoablation time was 95-146 (120.3±12.3) min, 82-115 (93.3±7.7) min and 32-48 (38.6±4.5) min, respectively. There was no death perioperatively. The average postoperative length of hospital stay was 5-16 (7.9±1.9) d. At discharge, 44 patients (44/47, 93.6%) maintained sinus rhythm. At a mean follow-up of 6-26 (14.4±5.4) months, sinus rhythm was maintained in 41 patients (41/47, 87.2%). Cumulative maintenance rate of normal sinus rhythm without AF recurrence at one year postoperatively was 86.3%±5.8%. Conclusion Biatrial Cox Maze Ⅳ cryoablation procedure is safe, feasible and effective for AF during concomitant minimally invasive valve surgery.

Citation： JIANGZhaolei, MEIJu, TANGMin, MANan, LIUHao, YINHang, HEYi. Biatrial Cox Maze Ⅳ cryoablation procedure combined with minimally invasive mitral valve surgery for concomitant atrial fibrillation . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 25-29. doi: 10.7507/1007-4848.201605026 Copy

1.	Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3): 909-914.
2.	Lawrance CP, Henn MC, Damiano RJ Jr. Concomitant Cox-Maze IV techniques during mitral valve surgery. Ann Cardiothorac Surg, 2015, 4(5): 483-486.
3.	Ad N, Henry L, Massimiano P, et al. The state of surgical ablation for atrial fibrillation in patients with mitral valve disease. Curr Opin Cardiol, 2013, 28(2): 170-180.
4.	姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8): 482-485.
5.	Mariscalco G, Musumeci F. The minithoracotomy approach: a safe and effective alternative for heart valve surgery. Ann Thorac Surg, 2014, 97(1): 356-364.
6.	Vollroth M, Seeburger J, Garbade J, et al. Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy. Eur J Cardiothorac Surg, 2012, 42(1): e13-e15.
7.	Ward AF, Grossi EA, Galloway AC. Minimally invasive mitral surgery through right mini-thoracotomy under direct vision. J Thorac Dis, 2013, 5(Suppl 6): S673-S679.
8.	Goldstone AB, Atluri P, Szeto WY, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg, 2013, 145(3): 748-756.
9.	Ad N, Henry L, Hunt S. The concomitant cryosurgical Cox-Maze procedure using Argon based cryoprobes: 12 month results. J Cardiovasc Surg (Torino), 2011, 52(4): 593-599.
10.	Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
11.	姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.
12.	Ad N, Holmes SD, Massimiano PS, et al. The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1426-1434.
13.	Solinas M, Bevilacqua S, Karimov JH, et al. A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during minimally invasive mitral valve surgery. Eur J Cardiothorac Surg, 2010, 37(4): 965-966.
14.	Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15(4): 741-748.
15.	Melby SJ, Schuessler RB, Damiano RJ Jr. Ablation technology for the surgical treatment of atrial fibrillation. ASAIO J, 2013, 59(5): 461-468.
16.	Higuchi K. A modified cryo-maze procedure via the superior transseptal approach. Asian Cardiovasc Thorac Ann, 2015, 23(1): 114-116.
17.	Takasaki T, Sueda T, Imai K, et al. Mid-term results of the box pulmonary vein isolation and the cryo-maze procedure for chronic atrial fibrillation associated with mitral valve disease. Gen Thorac Cardiovasc Surg, 2012, 60(2): 82-89.
18.	Camm CF, Nagendran M, Xiu PY, et al. How effective is cryoablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2011, 13(4): 410-414.
19.	Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitant Cox-maze III procedure using an argon-based cryosurgical system: a single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
20.	Goff RP, Bersie SM, Iaizzo PA. In vitro assessment of induced phrenic nerve cryothermal injury. Heart Rhythm, 2014, 11(10): 1779-1784.
21.	Rajbanshi BG, Rodrigues E, Lynch JJ, et al. Coronary artery spasm after Cryo Maze III procedure. Ann Thorac Surg, 2011, 92(5): 1884-1887.
22.	Cheema FH, Pervez MB, Mehmood M, et al. Does cryomaze injure the circumflex artery?: a preliminary search for occult post- procedure stenoses. Innovations (Phila), 2013, 8(1): 56-66.

1. Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3): 909-914.
2. Lawrance CP, Henn MC, Damiano RJ Jr. Concomitant Cox-Maze IV techniques during mitral valve surgery. Ann Cardiothorac Surg, 2015, 4(5): 483-486.
3. Ad N, Henry L, Massimiano P, et al. The state of surgical ablation for atrial fibrillation in patients with mitral valve disease. Curr Opin Cardiol, 2013, 28(2): 170-180.
4. 姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8): 482-485.
5. Mariscalco G, Musumeci F. The minithoracotomy approach: a safe and effective alternative for heart valve surgery. Ann Thorac Surg, 2014, 97(1): 356-364.
6. Vollroth M, Seeburger J, Garbade J, et al. Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy. Eur J Cardiothorac Surg, 2012, 42(1): e13-e15.
7. Ward AF, Grossi EA, Galloway AC. Minimally invasive mitral surgery through right mini-thoracotomy under direct vision. J Thorac Dis, 2013, 5(Suppl 6): S673-S679.
8. Goldstone AB, Atluri P, Szeto WY, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg, 2013, 145(3): 748-756.
9. Ad N, Henry L, Hunt S. The concomitant cryosurgical Cox-Maze procedure using Argon based cryoprobes: 12 month results. J Cardiovasc Surg (Torino), 2011, 52(4): 593-599.
10. Funatsu T, Kobayashi J, Nakajima H, et al. Long-term results and reliability of cryothermic ablation based maze procedure for atrial fibrillation concomitant with mitral valve surgery. Eur J Cardiothorac Surg, 2009, 36(2): 267-271.
11. 姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.
12. Ad N, Holmes SD, Massimiano PS, et al. The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1426-1434.
13. Solinas M, Bevilacqua S, Karimov JH, et al. A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during minimally invasive mitral valve surgery. Eur J Cardiothorac Surg, 2010, 37(4): 965-966.
14. Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15(4): 741-748.
15. Melby SJ, Schuessler RB, Damiano RJ Jr. Ablation technology for the surgical treatment of atrial fibrillation. ASAIO J, 2013, 59(5): 461-468.
16. Higuchi K. A modified cryo-maze procedure via the superior transseptal approach. Asian Cardiovasc Thorac Ann, 2015, 23(1): 114-116.
17. Takasaki T, Sueda T, Imai K, et al. Mid-term results of the box pulmonary vein isolation and the cryo-maze procedure for chronic atrial fibrillation associated with mitral valve disease. Gen Thorac Cardiovasc Surg, 2012, 60(2): 82-89.
18. Camm CF, Nagendran M, Xiu PY, et al. How effective is cryoablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2011, 13(4): 410-414.
19. Yanagawa B, Holmes SD, Henry L, et al. Outcome of concomitant Cox-maze III procedure using an argon-based cryosurgical system: a single-center experience with 250 patients. Ann Thorac Surg, 2013, 95(5): 1633-1639.
20. Goff RP, Bersie SM, Iaizzo PA. In vitro assessment of induced phrenic nerve cryothermal injury. Heart Rhythm, 2014, 11(10): 1779-1784.
21. Rajbanshi BG, Rodrigues E, Lynch JJ, et al. Coronary artery spasm after Cryo Maze III procedure. Ann Thorac Surg, 2011, 92(5): 1884-1887.
22. Cheema FH, Pervez MB, Mehmood M, et al. Does cryomaze injure the circumflex artery?: a preliminary search for occult post- procedure stenoses. Innovations (Phila), 2013, 8(1): 56-66.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Biatrial Cox Maze Ⅳ cryoablation procedure combined with minimally invasive mitral valve surgery for concomitant atrial fibrillation

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