Avoiding Atriotomy; the University Hospitals GP Maze: Operative Technique and Early Results.

G. Rushing¹, P. Ruda Vega^2
1University Hospitals, Case Western Reserve University, Cleveland, Ohio ²University Hospitals, Shaker Heights, Ohio

Purpose: The Cox-Maze procedure, for surgical treatment of atrial fibrillation, traditionally has required formal left/right atriotomies (even minimally invasive approaches) [1] [2]. This study describes a method using ablation technologies to create the full Cox-Maze lesion set, through the left atrial appendage, and purse-string access, used for retrograde cardioplegia cannula.

Methods: Sixteen consecutive patients, without need for atriotomy, received full Cox-IV maze lesions, using sternotomy and cardiopulmonary bypass. Surgical procedures included isolated CABG, combined CABG/AVR, and combined AVR/Ascending Aortic Aneurysm repair. The lesion sets were performed using a combination of radiofrequency and cryo-ablation energy sources. A box pulmonary vein isolation was performed using a bipolar radiofrequency energy clamp. Through the tip of the left atrial appendage, the mitral valve annular circuit interruption, and left atrial appendage circuit interruption lines were completed, using a cryoprobe. The Tricuspid annular circuit interruption line was completed using a cryoprobe via the retrograde coronary sinus catheter purse-string access. All other right atrial and coronary sinus lesions were completed epicardially, using a cryoprobe. Patients were followed prospectively with electrocardiogram and 7 day Holter monitoring at 3, 6, and 12 months.

Results: All operations were performed via full median sternotomy. The mean cardiopulmonary oxygenator time was (142 ±12 min); the mean aortic cross-clamp time was (95 ±5). There was no operative mortality or intraoperative complications. One patient developed a post-operative stroke. No patients required a permanent pacemaker. At last follow-up (mean 12.5 ±10 months); all patients (n=16) were free from atrial dysrhythmias. At 3 months (n=14), 87% of patients were off antiarrhythmic drugs. At 6 and 12 months (n=15), 94% of patients were free from AF and off antiarrhythmic medications. Three patients (19%) remained on anticoagulation for non-arrhythmia indications.

Conclusion: A full set of Cox-IV lesions can be performed without need for bi-caval cannulation or atriotomy, with excellent short term results. Traditionally, these patients receive just a pulmonary vein isolation, or limited lesion sets. This procedure offers a complete ablation to patients without cumbersome access or cannulation techniques.

Identify the source of the funding for this research project: None