초록접수 현황
| 14F-248 | 포럼 발표 |
How to Improve Sinus Conversion Rate in Patients Who Undergo the Cox-maze Procedure - Update of Our Past Outcomes of the Cox-maze Procedure -
최종범, 김종헌, 차병기, 김경화, 이정문, 구자홍
전북대학교 의학전문대학원 흉부외과학교실
Background : Although the equipment for making ablation lesions in the Cox-Maze procedure were more advanced recently, sinus conversion rate was not improved for several years. For the purpose, we bring the operative procedures rather than the advanced equipment into focus, and then evaluated the outcomes of the Cox-Maze procedure.
Methods : One hundred-five patients (mean age, 59.6±10.1 years; female 64%) underwent the Cox-Maze procedure between October 2007 and June 2014. Bipolar radiofrquency electrode was used to make accurate ablation lines on the atrial wall, and cryoablator was used only on the coronary vessels. The ablation lines in the left atrium were made within 3.0 cm away from the mitral annulus. Whenever the left atrial wall was redundant between the ablation lesion and pulmonary vein apertures, the redundant wall was eradicated by plication suture. If the redundant atrial wall was thick, it was excised instead of plication and sutured. Biatrial maze procedure was performed in the same strategic method.
Results : At the mean follow-up period of 43.7 ± 22.8 months, 94.2% of patients (98/104) had sinus rhythm without sinus-converting medication (amiodarone, etc), and two other patients had incomplete sinus conversion on rhythm-controlling medication. The left atrial “A” wave presented more frequently with concomitant mitral valve repair than mitral valve replacement (82.4% vs 44.7%; p < 0.0001).
Conclusion : For the Cox-Maze procedure, accurate ablation for making a reasonable maze using bipolar radiofrquency electrode and reduction of redundant (dilated) atrial wall can increase and maintain sinus conversion rate in patients who undergo concomitant Cox-Maze procedure.
Methods : One hundred-five patients (mean age, 59.6±10.1 years; female 64%) underwent the Cox-Maze procedure between October 2007 and June 2014. Bipolar radiofrquency electrode was used to make accurate ablation lines on the atrial wall, and cryoablator was used only on the coronary vessels. The ablation lines in the left atrium were made within 3.0 cm away from the mitral annulus. Whenever the left atrial wall was redundant between the ablation lesion and pulmonary vein apertures, the redundant wall was eradicated by plication suture. If the redundant atrial wall was thick, it was excised instead of plication and sutured. Biatrial maze procedure was performed in the same strategic method.
Results : At the mean follow-up period of 43.7 ± 22.8 months, 94.2% of patients (98/104) had sinus rhythm without sinus-converting medication (amiodarone, etc), and two other patients had incomplete sinus conversion on rhythm-controlling medication. The left atrial “A” wave presented more frequently with concomitant mitral valve repair than mitral valve replacement (82.4% vs 44.7%; p < 0.0001).
Conclusion : For the Cox-Maze procedure, accurate ablation for making a reasonable maze using bipolar radiofrquency electrode and reduction of redundant (dilated) atrial wall can increase and maintain sinus conversion rate in patients who undergo concomitant Cox-Maze procedure.
책임저자: 최종범
전북대학교 의학전문대학원 흉부외과학교실
연락처 : 김종헌, Tel: 063-250-1485 , E-mail : kim77jh@jbnu.ac.kr
