The Annals of thoracic surgery · 2000
The maze III procedure for atrial fibrillation: should the indications be expanded?
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Millar R C, Arcidi J M, Alison P J
Аннотация
BACKGROUND: We favor the maze III procedure over nonsurgical treatments for atrial fibrillation and have advocated addition of the maze in symptomatic patients with other compelling indications for cardiac surgery.
METHODS: Characteristics and perioperative outcomes of our 76 cumulative maze recipients between 1993 to 1998 were reviewed. The original maze III technique was employed without modification.
RESULTS: Isolated maze III was performed in 19 patients (25%) and combined with other procedures in 57 patients (75%), 49 of these involving one or more valves. Patients having combined procedures were taking fewer antiarrhythmics (p < 0.0001), but were older (p < 0.01), more often female (p < 0.05), and more often had chronic atrial fibrillation (p < 0.01) compared with isolated maze III recipients. The mean duration of aortic clamping and cardiopulmonary bypass for isolated maze was 69 +/- 11 and 145 +/- 22 minutes, and for combined valve procedures it was 122 +/- 38 and 205 +/- 47 minutes. There was no operative mortality. Complications occurred in 15 patients (19.7%). At 3 months atrial fibrillation was cured in 73 of 75 patients (97.3%). Sick sinus syndrome required pacemaker implantation in 3 patients (4.0%).
CONCLUSIONS: The maze III can be performed alone or as a combined procedure with equivalent success, and technical modifications may be unnecessary. A lower threshold for its expanded use in symptomatic patients with atrial fibrillation who require isolated or combined operations is appropriate.
METHODS: Characteristics and perioperative outcomes of our 76 cumulative maze recipients between 1993 to 1998 were reviewed. The original maze III technique was employed without modification.
RESULTS: Isolated maze III was performed in 19 patients (25%) and combined with other procedures in 57 patients (75%), 49 of these involving one or more valves. Patients having combined procedures were taking fewer antiarrhythmics (p < 0.0001), but were older (p < 0.01), more often female (p < 0.05), and more often had chronic atrial fibrillation (p < 0.01) compared with isolated maze III recipients. The mean duration of aortic clamping and cardiopulmonary bypass for isolated maze was 69 +/- 11 and 145 +/- 22 minutes, and for combined valve procedures it was 122 +/- 38 and 205 +/- 47 minutes. There was no operative mortality. Complications occurred in 15 patients (19.7%). At 3 months atrial fibrillation was cured in 73 of 75 patients (97.3%). Sick sinus syndrome required pacemaker implantation in 3 patients (4.0%).
CONCLUSIONS: The maze III can be performed alone or as a combined procedure with equivalent success, and technical modifications may be unnecessary. A lower threshold for its expanded use in symptomatic patients with atrial fibrillation who require isolated or combined operations is appropriate.