Document Detail


The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease.
MedLine Citation:
PMID:  10509965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The surgical results of the Cox-Maze III procedure (CM-III) for atrial fibrillation (AF) associated with rheumatic mitral valve (MV) disease are not as good as the results from surgery for AF alone. METHODS: To assess the efficacy and safety of the CM-III in AF associated with rheumatic MV disease, we retrospectively analyzed 75 patients who underwent the CM-III combined with a rheumatic MV procedure between April 1994 and December 1997. Fourteen cases were reoperations because of prosthetic valve failure. RESULTS: Mean aortic cross-clamp (ACC) times and cardiopulmonary bypass (CPB) times were 151+/-43 and 251+/-73 min, respectively. Concomitant procedures were mitral valve replacement (MVR) in 25 patients, MVR and aortic valve replacement (AVR) in 14 patients, MV repair in 10 patients, MVR and tricuspid annuloplasty (TAP) in 6 patients, MVR and AV repair in 3 patients, MVR and coronary artery bypass grafting (CABG) in 2 patients, MVR and AVR and CABG in 1 patient, redo-MVR in 8 patients, redo-MVR and TAP in 4 patients, and redo-MVR and redo-AVR in 2 patients. There were two in-hospital mortalities (2 of 75, 2.7%). Seventy-three survivors were followed for a mean duration of 30+/-13 months (12-56 months). Normal sinus rhythm was restored in 90.4% (66 of 73). Three patients remained in AF and 2 patients were in junctional rhythm. Permanent pacemakers were implanted in 2 patients due to sick sinus syndrome. Right atrial (RA) contractility was demonstrable in 100% (66 of 66) and left atrial (LA) contractility in 62.1% (41 of 66) of the patients in the latest follow-up echocardiography. RA and LA contractilities were restored a mean 69+/-93 and 126+/-136 days after the operation, respectively. LA contractility was restored significantly later at a lower rate than RA contractility in rheumatic MV disease. There were no differences in ACC time, CPB time, incidence of postoperative bleeding complications, and sinus conversion rates between non-redo and redo cases in spite of the significantly longer duration of preoperative AF in redo cases (p<0.05). CONCLUSIONS: The CM-III for AF associated with rheumatic MV disease demonstrated a high sinus conversion rate with acceptable operative risk even in cases of reoperation.
Authors:
K B Kim; K R Cho; D W Sohn; H Ahn; J R Rho
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  68     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-15     Completed Date:  1999-10-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  799-803; discussion 803-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atrial Fibrillation / etiology,  physiopathology,  surgery*
Cardiac Surgical Procedures / mortality
Female
Heart Rate
Heart Valve Diseases / complications,  surgery
Heart Valves / surgery
Humans
Male
Middle Aged
Mitral Valve* / surgery
Myocardial Contraction
Postoperative Complications
Reoperation
Retrospective Studies
Rheumatic Heart Disease / complications*,  surgery
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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