Comparative efficacy of the maze procedure for restoration of atrial contraction in patients with and without giant left atrium associated with mitral valve disease

Division of Cardiology, National Cardiovascular Center, Osaka, Japan.

OBJECTIVES: We sought to determine the effectiveness of the maze procedure for restoring atrial contraction in patients with and without giant left atrium (GLA). BACKGROUND: Although the maze procedure has been reported to be effective for refractory atrial fibrillation, it is unknown whether this procedure can restore effective atrial contraction in patients with GLA. METHODS: Nineteen patients with and 32 patients without GLA were studied with Doppler echocardiography before and after the maze procedure. Peak velocity and the time-velocity integral of the left ventricular diastolic filling wave during atrial contraction (A wave) and the atrial filling fraction calculated as the ratio of the time-velocity integral of the A wave to that of total diastolic filling were compared between patients with and without GLA. A peak A wave velocity > or =10 cm/s was considered to indicate echocardiographic evidence of effective atrial contraction. RESULTS: Regular rhythm with P waves was restored in 10 patients (53%) with and 26 (81%, p < 0.05) without GLA. Four patients (21%) with and 21 patients (66%, p < 0.01) without GLA showed effective atrial contraction by echocardiography. Once atrial contraction was resumed, the degree of atrial contraction was comparable between patients with and without GLA (17+/-5% vs. 17+/-4% for atrial filling fraction at 12 months, respectively). CONCLUSIONS: Although most patients without GLA had restored atrial contraction by the maze procedure, it was resumed in fewer patients with GLA. However, once atrial contraction was resumed, the degree of atrial contraction was comparable between patients with and without GLA. Therefore, the maze procedure may be an option in selected patients with GLA.

This article has been cited by other articles:

				G. G. Blume, C. J. Mcleod, M. E. Barnes, J. B. Seward, P. A. Pellikka, P. M. Bastiansen, and T. S. M. Tsang Left atrial function: physiology, assessment, and clinical implications Eur Heart J Cardiovasc Imaging, June 1, 2011; 12(6): 421 - 430. [Abstract] [Full Text] [PDF]

				K. Yamanaka, Y. Sekine, M. Nonaka, A. Iwakura, K. Yoshitani, Y. Nakagawa, and M. Fujita Left atrial appendage contributes to left atrial booster function after the maze procedure: quantitative assessment with multidetector computed tomography Eur J Cardiothorac Surg, September 1, 2010; 38(3): 361 - 365. [Abstract] [Full Text] [PDF]

				Y.-q. Cui, Y. Li, F. Gao, C.-l. Xu, J. Han, W. Zeng, Y.-p. Zeng, E. Gurbanov, and X. Meng Video-assisted minimally invasive surgery for lone atrial fibrillation: A clinical report of 81 cases J. Thorac. Cardiovasc. Surg., February 1, 2010; 139(2): 326 - 332. [Abstract] [Full Text] [PDF]

				E. Apostolakis and J. H. Shuhaiber The surgical management of giant left atrium Eur J Cardiothorac Surg, February 1, 2008; 33(2): 182 - 190. [Abstract] [Full Text] [PDF]

				S. L. Gaynor, R. B. Schuessler, M. S. Bailey, Y. Ishii, J. P. Boineau, M. J. Gleva, J. L. Cox, and R. J. Damiano Jr Surgical treatment of atrial fibrillation: Predictors of late recurrence J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 104 - 111. [Abstract] [Full Text] [PDF]

				S. J. Choo, N. H. Park, S. K. Lee, J. W. Kim, J. K. Song, H. Song, M. G. Song, and J. W. Lee Excellent results for atrial fibrillation surgery in the presence of giant left atrium and mitral valve disease Eur J Cardiothorac Surg, August 1, 2004; 26(2): 336 - 341. [Abstract] [Full Text] [PDF]

				M. A. Romano, D. S. Bach, F. D. Pagani, R. L. Prager, G. M. Deeb, and S. F. Bolling Atrial reduction plasty Cox maze procedure: extended indications for atrial fibrillation surgery Ann. Thorac. Surg., April 1, 2004; 77(4): 1282 - 1287. [Abstract] [Full Text] [PDF]

				S Yuda, S Nakatani, Y Kosakai, T Satoh, Y Goto, M Yamagishi, K Bando, S Kitamura, and K Miyatake Mechanism of improvement in exercise capacity after the maze procedure combined with mitral valve surgery Heart, January 1, 2004; 90(1): 64 - 69. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. C. Kelder, J. A.M.T. Defauw, A. Brutel de la Riviere, J. M.P.G. Ernst, and W. Jaarsma The effect of maze operations on atrial volume Ann. Thorac. Surg., January 1, 2003; 75(1): 51 - 56. [Abstract] [Full Text] [PDF]

				S. Benussi, S. Nascimbene, E. Agricola, G. Calori, S. Calvi, A. Caldarola, M. Oppizzi, V. Casati, C. Pappone, and O. Alfieri Surgical ablation of atrial fibrillation using the epicardial radiofrequency approach: mid-term results and risk analysis Ann. Thorac. Surg., October 1, 2002; 74(4): 1050 - 1057. [Abstract] [Full Text] [PDF]

				E. P. Bauer, Z. A. Szalay, R. R. Brandt, H. F. Pitschner, G. Bachmann, H.-P. Brunner-La Rocca, and W. P. Klovekorn Predictors for atrial transport function after mini-maze operation Ann. Thorac. Surg., October 1, 2001; 72(4): 1251 - 1255. [Abstract] [Full Text] [PDF]

				S. Yuda, S. Nakatani, Y. Kosakai, M. Yamagishi, and K. Miyatake Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1622 - 1627. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. C. Kelder, S. Elbers, A. B. de la Riviere, J. J. A. M. Defauw, and J. M. P. G. Ernst Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg, May 1, 2000; 17(5): 530 - 537. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. A. M. T. Defauw, M. A. M. Stofmeel, J. C. Kelder, A. Brutel de la Riviere, and J. M. P. G. Ernst Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation Circulation, April 4, 2000; 101(13): 1559 - 1567. [Abstract] [Full Text] [PDF]