Objective To evaluate the efficacy of Radiofrequency （RF） modified maze procedure combined with open-heart surgery for atrial fibrillation （AF）. Methods From January 2003 to October 2004, 66 patients underwent the RF modified maze Ⅲ procedure for AF combined with open-heart surgery. The preoperative and postoperative indexes of electrocardiogram and echoeardiogram were compared through retrospective analysis and follow-up. Postoperative cardiac function and thromboembolie events were evaluated through telephone and mail. Results The time needed for RF modified maze Ⅲ was 18.61±3.56 min. There were no hospital deaths and the complications was 15.15%（10/66）. Follow-up duration was 14.25±6.47 months with 95.45%（63/66） completion. At the lastest follow-up, the rate of freedom from AF was 80.95% （51/63）and the rate of restoration to sinus rhythm was 74.60%（47/63）. No thromboembolic events was seen. 77.78%（49/63） of patients were in NYHA class Ⅰ. Significant decrease was seen in both left atrial dimension （LAD） and left ventricular dimension （LVD）（P〈0.01） more than 6 months after operation. Conclusion RF modified maze Ⅲ procedure as an adjunctive procedure is safe, time-sparing and effective in eliminating AF.
Atrial fibrillation （AF） is the most common cardiac arrhythmia and associated with incremental morbidity and mortality. It is implicated that multiple reentry circuits have been the dominant mechanism of AF. The classical surgical treatment for medically refractory AF is the maze procedure composed of aultiple cuts and sutures within the atrial walls to disrupt the abnormal reentry circuits. Although the maze procedure is recognized as the most effective treatment of AF, it is complicated, time consuming and much invasive. New surgical ablation therapy, applying alternate energy sources （cryothermy, radiofrequency, microwave） have evolved to simplify the maze procedure without cut and suture and demonstrated promising success rates. The optimal lesion set has not yet been defined, Modification of lesion sets and techniques that ensure continuous and transmural lesions may improve the outcomes of ablation therapy and recover rate of sinus rhythm.
It is widely believed that thrombus detachment from left atrial appendage (LAA) is closely related to cerebral embolism in patients with the increased risk of stroke in atrial fibrillation (AF) patients. About 30% AF is generated in LAA. Thus, LAA intervention may reduce the thromboembolism and AF recurrence in AF patients. Currently, more and more physicians are interested in LAA intervention for the treatment of AF. This review focuses on research progress of the LAA intervention in surgical treatment of AF.
ObjectiveTo evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.MethodsFrom May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups.ResultsAfter PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05).ConclusionThe mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.
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.