ObjectiveTo analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery.MethodsWe retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram.ResultsNo death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively.ConclusionConcomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.
Atrial fibrillation is the most common arrhythmia and is known to be in connection with stroke, dementia, heart failure and increased risk of death. For drug-refractory atrial fibrillation, surgical or catheter ablation is recommended. Early attempts to design procedures to ablate atrial fibrillation and restore sinus rhythm culminated in the Cox-Maze Ⅲ procedure, which was the first truly successful procedure. However, Cox-Maze Ⅲ procedure is complex and technically demanding, so it has been extensively modified with new techniques to create new types of surgical ablation procedures: Cox-Maze Ⅳ procedure, minimally invasive Cox-Maze Ⅳ procedure, and the latest “hybrid approach”. This review mainly discusses these surgical treatment strategies and the latest research progress.