Although a septal-superior approach provides excellent exposure of the mitral valve, it requires novel strategies for concomitant ablation in patients with atrial fibrillation. Utilizing a combination of bipolar radiofrequency and cryothermy, we developed a novel technique for creating a biatrial lesion set via a septal-superior approach during mitral valve surgery. We treated 10 patients with functional mitral regurgitation and permanent atrial fibrillation with rhythm disturbance for a mean 87 months. A modified maze was successfully accomplished via a septal-superior approach in all. The mean follow-up period was 18 months, during which permanent pacemaker implantation was necessary for one due to sinus bradycardia. Sustained sinus rhythm, including atrial or atrial-based paced rhythm, was present in all immediately after surgery, in 70% at discharge, in 80% at 1 year after surgery, and in 90% at the latest follow-up examination. Our novel technique using a modified maze procedure in combination with mitral valve surgery via a septal-superior approach was safe and useful for eliminating atrial fibrillation, with a relatively low frequency of sinus node dysfunction.
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Novel surgical ablation through a septal-superior approach for valvular atrial fibrillation: 7-year single-centre experience.
Eur J Cardiothorac Surg
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Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital, Sakai, Osaka, Japan.
Article Synopsis
- A study evaluated mid-term results of the 'trans-septal maze procedure' for patients undergoing mitral valve surgery to treat atrial fibrillation (AF) and assessed the impact of restored left atrial (LA) contraction.
- Among 50 patients with persistent or long-standing persistent AF, 96% were free from AF immediately post-surgery, but 78% remained AF-free during follow-up, with 56% showing LA mechanical contraction.
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Modified maze procedure combined with mitral valve surgery via septal-superior approach.
Eur J Cardiothorac Surg
July 2009
Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Although a septal-superior approach provides excellent exposure of the mitral valve, it requires novel strategies for concomitant ablation in patients with atrial fibrillation. Utilizing a combination of bipolar radiofrequency and cryothermy, we developed a novel technique for creating a biatrial lesion set via a septal-superior approach during mitral valve surgery. We treated 10 patients with functional mitral regurgitation and permanent atrial fibrillation with rhythm disturbance for a mean 87 months.
View Article and Find Full Text PDFSeptal-superior exposure in mitral valve surgery with radiofrequency ablation.
ANZ J Surg
March 2007
Department of Cardiovascular Surgery, Teikyo University School on Medicine, Tokyo, Japan.
Background: We review the results of surgical radiofrequency ablation of both atria in patients of mitral valve disease approached by septal-superior exposure and discuss the availability of this approach.
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Department of Pediatric Cardiovasucular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Mitral valve replacement was successfully performed in a 13-year-old girl due to severely calcified mitral valve stenosis and pulmonary hypertension who had undergone renal transplantation from her father at the age of 8 years old. Although, percutaneous transluminal mitral commissurotomy had been performed for four times until January 1996, severe mitral stenosis could be relieved and she was transported to our hospital in emergency for respiratory failure caused by pulmonary edema. Then we decided to perform mitral valve replacement.
View Article and Find Full Text PDFSeptal-superior exposure of the mitral valve. The transplant approach.
J Thorac Cardiovasc Surg
April 1992
College of Physicians and Surgeons of Columbia University, Columbia Presbyterian Medical Center, New York, N.Y.
The technique used for transplant recipient cardiectomy can be modified to improve exposure of the mitral valve in patients with difficult anatomy. Right atrial and septal incisions are joined at the superior end of the interatrial septum and extended across the dome of the left atrium to the base of the left atrial appendage. Retraction of the right ventricle to the left bivalves the left atrium along an axis extending from the appendage to the inferior end of the septum, producing uniquely anterosuperior exposure of the mitral apparatus.
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