Short And Long-term Results Of The "Cox Maze v" Procedure For Treatment Atrial Fibrillation During Cabg
Amiran Revishvili, Vadim Popov, Egor Malyshenko, Maksim Anishchenko.
A.V.Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation.
BACKGROUND:The aim of this study is to analyze short- and long-term outcomes of the "Cox Maze V" procedure during CABG.
METHODS:This retrospective study included 70 patients with different types of AF and coronary artery disease (CAD) who had undergone CABG and "Cox Maze V" was observed. The "Cox Maze V" procedure includes ablation to left atrium (performing Box Lesion set using bipolar RF clamp) and right atrium (cavacaval lesion sets, cavatricuspid isthmus isolation) using parallel CBP and «on-pump» approach. That allows to accomplish an adequate ablation, restore sinus rhythm and conduct an electrophysiological study. Mean age was 61±7.2 and 94.2% were male. Total 48 (68.6%) patients had severe angina (III-IV CCS). Incidence of persistent AF was 44.8% and longstanding persistent AF- 57.2%.The mean duration of AF was 7.6±6.8 years.
RESULTS:The mean operative time was 370±73.2 min, CBP time-138±28.3 min, X-clamp time- 40.8±17.8 min. Mean time of the ablation stage was 54.8±17.8 min. Intraoperative blood loss was 556±94 ml. Mean number of grafts was 2.5±0.35. No perioperative MIs, stroke, major bleeding events was documented. The rate of respiratory failure was 7.1% (5/70), pleural effusion - 10% (7/70). The recurrence of arrhythmia after surgery was 24.2% (17/70). Pacemaker implantation was 0%. SR maintained in 97.1% at the time of discharge. 2 patients were discharged with AF. Freedom from AF/AFL for 43.1±19.3 months had 84.7% patients in the long-term follow-up period. Freedom from MACCE was 93%.
CONCLUSIONS:Simultaneous Cox Maze V procedure in CABG is efficacy and safe procedure for treatment of concomitant atrial fibrillation, providing favorable in-hospital and long-term results.
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