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Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Lee et al. and Ad et al. have described a minimally invasive Cox maze III/IV procedure that is perhaps most similar to the conventional Cox maze procedure. The procedure is performed with cardiopulmonary bypass (CPB) via a right minithoracotomy, and creates a lesion pattern that closely mimics the original maze III pattern using cryotherapy [8,9] (Figure 13.3 to Figure 13.5.6).
Morphologic features and pathology of the elderly heart
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Atsuko Seki, Gregory A. Fishbein, Michael C. Fishbein
Macroscopically, atrial cavity dilation is seen in hearts with AF (Figure 2.1a) (13,82,143). Microscopic findings show sinoatrial muscle cell loss or fibrosis, disruption of the internodal atrial musculature by fibrosis and/or adipose tissue, or vascular occlusion of the SA nodal artery (82,143). Catheter ablation and the Cox maze procedure are sometimes employed for symptomatic paroxysmal or persistent AF (153). Macroscopically, following ablation the pulmonary vein orifices may show narrowing and there are yellow to white lesions on the endocardium several years after the procedures (Figure 2.10) (154,155). Microscopic examination shows that nontransmural-to-transmural coagulative necrosis, inflammation, and fibrosis depend on the time after the procedure.
The Belgian experience with concomitant surgical ablation of atrial fibrillation: a multi-centre prospective registry
Published in Acta Cardiologica, 2020
Lucas Van Hoof, Kristof De Brabandere, Steffen Fieuws, Bernard Stockman, Herbert Gutermann, Filip Rega
Since the first results of surgical treatment of atrial fibrillation (STAF) were published by James Cox in 1987 using the ‘cut-and-sew’ technique, STAF has evolved through multiple iterations [1,2]. Concomitant STAF using modern ablation devices has proven to increase long-term survival and decrease the incidence of stroke without increasing short-term mortality [3–6]. The Cox maze IV procedure, currently the gold standard for the treatment of AF, consisting of bipolar radiofrequency lesions and cryothermal ablation, produces equivalent rates of freedom of AF with less perioperative complications and shorter bypass and cross-clamp times than the ‘cut-and-sew’ Cox maze III procedure [7]. Both the most recent Heart Rhythm Society (HRS) and Society of Thoracic Surgeons (STS) guidelines recommend STAF with variable levels of evidence depending on, amongst others, the concomitant procedure [8,9]. Various renditions of the Cox-Maze procedure and derived lesion sets are still in use, complicating comparison of outcomes between clinical trials. Furthermore, the effectivity of commercially available ablation devices and their mutual differences remain uncertain. The safety and efficacy of STAF as performed throughout Belgium had never been investigated. Aforementioned considerations led to the inception of the ‘Belgian Atrial Fibrillation Management Database’, initiated by the National Institute for Health and Disability Insurance (RIZIV-INAMI) and carried out by the Belgian Association for CardioThoracic Surgery (BACTS). The retrospective analysis of this multi-centric, prospectively collected database is hereby presented.
Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation
Published in Expert Review of Cardiovascular Therapy, 2018
Jose M. Sanchez, Ghannam Al-Dosari, Sherman Chu, Ramin Beygui, Tobias Deuse, Nitish Badhwar, Randall J. Lee
It is clear that catheter ablation of persistent AF is not sufficient to result in lower AF recurrence. As a result, surgical approaches and hybrid epicardial-endocardial ablation strategies have emerged. The surgical Cox maze procedure was first introduced in 1987 and initially consisted of complicated ‘maze’ incisions in both atria designed to interrupt macroreentrant circuits as well as isolate the sinus node and interrupt Bachmann’s bundle [19–21]. The Cox maze procedure quickly demonstrated the utility of a nonpharmacological strategy for treatment of AF and underwent a series of improvements culminating in the Cox maze III procedure. The Cox maze III procedure includes isolation of the PVs and elimination of the LAA with atrial incisions resulting in left atrial debulking. This has shown maintenance of sinus rhythm to be greater than 96% at 10 years [21] and is currently the gold standard for surgical treatment of AF [7]. Given the complexity of the ‘cut-and-sew’ Cox maze III procedure combined with improved understanding of the anatomic substrate of AF and development of various energy sources for ablation has led to the development of the Cox maze IV procedure [22,23]. Instead of creating atrial incisions, ablation lines are formed which have been shown to be as effective as the Cox maze III procedure for curing AF [22,23]. The most recent AHA/ACC/HRS guidelines indicate that adjuvant surgical ablation is reasonable, class IIa recommendation, for those undergoing cardiac surgery [14]. This success has led to the development of minimally invasive surgery that can be performed epicardially and off cardiopulmonary bypass.
Innovative tools for atrial fibrillation ablation
Published in Expert Review of Medical Devices, 2020
Laura Rottner, Daniela Waddell, Tina Lin, Andreas Metzner, Andreas Rillig
Currently, the majority of ablations are catheter-based and interventional catheter ablation for AF continues to evolve. The first successful surgical approach raised in 1987 and is known as the Cox-Maze procedure [81]. As this procedure is complex and technically demanding, it has been modified with novel techniques and energy sources for creation of linear lesions, minimally invasive surgical techniques, and most recently a so-called hybrid surgical-catheter ablation strategy.