BACKGROUND: The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with atrial fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. METHODS: A prospective clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1). associated en bloc isolation of pulmonary veins, (2). the Maze procedure, or (3). mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. RESULTS: The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins (p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group (p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. CONCLUSIONS: En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation.
RCT Entities:
BACKGROUND: The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with atrial fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. METHODS: A prospective clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1). associated en bloc isolation of pulmonary veins, (2). the Maze procedure, or (3). mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. RESULTS: The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins (p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group (p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. CONCLUSIONS: En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation.
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: A Marc Gillinov; Michael Argenziano; Eugene H Blackstone; Alexander Iribarne; Joseph J DeRose; Gorav Ailawadi; Mark J Russo; Deborah D Ascheim; Michael K Parides; Evelio Rodriguez; Denis Bouchard; Wendy C Taddei-Peters; Nancy L Geller; Michael A Acker; Annetine C Gelijns Journal: J Thorac Cardiovasc Surg Date: 2011-05-25 Impact factor: 5.209
Authors: A Marc Gillinov; Annetine C Gelijns; Michael K Parides; Joseph J DeRose; Alan J Moskowitz; Pierre Voisine; Gorav Ailawadi; Denis Bouchard; Peter K Smith; Michael J Mack; Michael A Acker; John C Mullen; Eric A Rose; Helena L Chang; John D Puskas; Jean-Philippe Couderc; Timothy J Gardner; Robin Varghese; Keith A Horvath; Steven F Bolling; Robert E Michler; Nancy L Geller; Deborah D Ascheim; Marissa A Miller; Emilia Bagiella; Ellen G Moquete; Paula Williams; Wendy C Taddei-Peters; Patrick T O'Gara; Eugene H Blackstone; Michael Argenziano Journal: N Engl J Med Date: 2015-03-16 Impact factor: 91.245
Authors: Eugene H Blackstone; Helena L Chang; Jeevanantham Rajeswaran; Michael K Parides; Hemant Ishwaran; Liang Li; John Ehrlinger; Annetine C Gelijns; Alan J Moskowitz; Michael Argenziano; Joseph J DeRose; Jean-Phillipe Couderc; Dan Balda; François Dagenais; Michael J Mack; Gorav Ailawadi; Peter K Smith; Michael A Acker; Patrick T O'Gara; A Marc Gillinov Journal: J Thorac Cardiovasc Surg Date: 2018-07-27 Impact factor: 5.209
Authors: Anders Jönsson; Mika Lehto; Henrik Ahn; Ulf Hermansson; Peter Linde; Anders Ahlsson; Juhani Koistinen; Jukka Savola; Pekka Raatikainen; Martti Lepojärvi; Antero Sahlman; Kalervo Werkkala; Lauri Toivonen; Håkan Walfridsson Journal: J Atr Fibrillation Date: 2012-08-20
Authors: Mark D Huffman; Kunal N Karmali; Mark A Berendsen; Adin-Cristian Andrei; Jane Kruse; Patrick M McCarthy; S C Malaisrie Journal: Cochrane Database Syst Rev Date: 2016-08-22