TY - JOUR
T1 - A minimally invasive stand-alone cox-maze procedure is as effective as median sternotomy approach
AU - Schill, Matthew R.
AU - Sinn, Laurie A.
AU - Greenberg, Jason W.
AU - Henn, Matthew C.
AU - Lancaster, Timothy S.
AU - Schuessler, Richard B.
AU - Maniar, Hersh S.
AU - Damiano, Ralph J.
N1 - Publisher Copyright:
© 2017 by the International Society for Minimally Invasive.
PY - 2017
Y1 - 2017
N2 - Objective: The Cox-Maze IV procedure has been shown to be an effective treatment for atrial fibrillation when performed concomitantly with other operations either via median sternotomy or right minithoracotomy. Few studies have compared these approaches in patients with lone atrial fibrillation. This study examined outcomes with sternotomy versus minithoracotomy in stand-alone Cox-Maze IV procedures at our institution. Methods: Between 2002 and 2015, 195 patients underwent stand-alone biatrial Cox-Maze IV.Minithoracotomywas used in 75 patients, sternotomy in 120. Freedom fromatrial tachyarrhythmiaswas ascertained using electrocardiography, Holter, or pacemaker interrogation at 3 to 60 months. Predictors of recurrence were determined using logistic regression. Results: Of 23 preoperative variables, the only differences between groups were that minithoracotomy patients had a higher rate of New York Heart Association 3/4 symptoms and a lower rate of previous stroke. Minithoracotomy and sternotomy patients had similar atrial fibrillation duration and type.Minithoracotomy patients had a smaller left atrial diameter (4.5 vs 4.8 cm, P = 0.03). More minithoracotomy patients received a box lesion (73/75 vs 100/120, P = 0.002). Minithoracotomy patients had a shorter hospital stay (7 vs 8 days, P = 0.009) and a similar rate of major complications (3/75 (4%) vs 7/120 (6%), P = 0.74). There were no differences in mortality or freedom from atrial tachyarrhythmias. Predictors of atrial fibrillation recurrence included a preoperative pacemaker, omission of the left atrial roof line, and New York Heart Association 3/4 symptoms. Conclusions: Stand-alone Cox-Maze IV via minithoracotomy was as effective as via sternotomy with a shorter hospital stay. A minimally invasive approach is our procedure of choice.
AB - Objective: The Cox-Maze IV procedure has been shown to be an effective treatment for atrial fibrillation when performed concomitantly with other operations either via median sternotomy or right minithoracotomy. Few studies have compared these approaches in patients with lone atrial fibrillation. This study examined outcomes with sternotomy versus minithoracotomy in stand-alone Cox-Maze IV procedures at our institution. Methods: Between 2002 and 2015, 195 patients underwent stand-alone biatrial Cox-Maze IV.Minithoracotomywas used in 75 patients, sternotomy in 120. Freedom fromatrial tachyarrhythmiaswas ascertained using electrocardiography, Holter, or pacemaker interrogation at 3 to 60 months. Predictors of recurrence were determined using logistic regression. Results: Of 23 preoperative variables, the only differences between groups were that minithoracotomy patients had a higher rate of New York Heart Association 3/4 symptoms and a lower rate of previous stroke. Minithoracotomy and sternotomy patients had similar atrial fibrillation duration and type.Minithoracotomy patients had a smaller left atrial diameter (4.5 vs 4.8 cm, P = 0.03). More minithoracotomy patients received a box lesion (73/75 vs 100/120, P = 0.002). Minithoracotomy patients had a shorter hospital stay (7 vs 8 days, P = 0.009) and a similar rate of major complications (3/75 (4%) vs 7/120 (6%), P = 0.74). There were no differences in mortality or freedom from atrial tachyarrhythmias. Predictors of atrial fibrillation recurrence included a preoperative pacemaker, omission of the left atrial roof line, and New York Heart Association 3/4 symptoms. Conclusions: Stand-alone Cox-Maze IV via minithoracotomy was as effective as via sternotomy with a shorter hospital stay. A minimally invasive approach is our procedure of choice.
KW - Atrial fibrillation
KW - Cox-Maze IV procedure
KW - Minimally invasive cardiac surgery.
KW - Surgical ablation
UR - http://www.scopus.com/inward/record.url?scp=85019741513&partnerID=8YFLogxK
U2 - 10.1097/IMI.0000000000000374
DO - 10.1097/IMI.0000000000000374
M3 - Article
C2 - 28549027
AN - SCOPUS:85019741513
SN - 1556-9845
VL - 12
SP - 186
EP - 191
JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
IS - 3
ER -