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The Prognostic Scoring System Establishment and Validation for Chronic Atrial Fibrillation Patients Receiving Modified Cox-Maze IV and Concomitant Cardiac Surgery.

Tsai FC, Ho HT, Chang JP, Tsai FC, Chu JJ, Lin PJ - PLoS ONE (2015)

Bottom Line: We try to establish a scoring system to predict the outcome of this procedure.The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively.In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University of Medicine, Kwei-Shan, Taoyuan, Taiwan; Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

ABSTRACT

Objectives: Traditional Cox maze III is the gold standard for treatment of atrial fibrillation (AF). Because of its invasiveness, it has been replaced by a simplified procedure involving radiofrequency ablation of modified Cox maze IV. Although the modified Cox maze IV has the advantages of simplicity and less morbidity, a lower rate of sinus rhythm conversion has been reported. We try to establish a scoring system to predict the outcome of this procedure.

Methods and results: The derivation group consisted of 287 patients with structural heart disease and chronic AF who underwent cardiac surgery and modified Cox-maze IV procedure between August 2005 and March 2013. Demographics, clinical and laboratory variables were retrospectively collected as sinus conversional predictors. Overall sinus conversion rate was 75.8%. The parameters of the Soft Markers Scoring system included AF duration, preoperative left atrial (LA) size, rheumatic pathology and postoperative LA remodeling. We compared 80 patients from another hospital between January 2004 and December 2011 as a validation group to evaluate the power of the scoring system. Soft Markers Score indicated a good discriminative power by using the areas under the receiver operating characteristic curve (AUROC: 0.759 ± 0.032). The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively.

Conclusions: In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.

No MeSH data available.


Related in: MedlinePlus

Lesion set of the modified Cox-maze IV procedure, Left atrium.1. Pulmonary veins isolation: Twice under beating heart. 2. Connect bilateral PV: Double line. 3. Connect to mitral annulus: Twice. 4. Connect LAA to LPV. 5. Suture closure of LAA: From interior, double layers. Additional procedures: divide ligament of Marshall; LA volume reduction. (PV: Pulmonary vein, LAA: Left atrial appendix, LPV: Left pulmonary vein, LA: Left atrium)
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pone.0126300.g001: Lesion set of the modified Cox-maze IV procedure, Left atrium.1. Pulmonary veins isolation: Twice under beating heart. 2. Connect bilateral PV: Double line. 3. Connect to mitral annulus: Twice. 4. Connect LAA to LPV. 5. Suture closure of LAA: From interior, double layers. Additional procedures: divide ligament of Marshall; LA volume reduction. (PV: Pulmonary vein, LAA: Left atrial appendix, LPV: Left pulmonary vein, LA: Left atrium)

Mentions: Patients of the derivation group were operated on by three senior surgeons with technical unity and the first ten cases were excluded to avoid learning curve bias. Our routine approach was standard full sternotomy with bicaval cannulations, and AF ablation lesion sets were similar to traditional Cox-Maze III except most cut-and-sew lesions were replaced by the RF ablation device and separated pulmonary vein isolation with two connecting lesions of both superior and inferior pulmonary veins. [7] The complete lesion sets were as the Fig 1 and Fig 2. Additional cryoablation of mitral isthmus was applied with cryoprobe for 2 minutes. Bi-atrial ablation was applied in most cases and left atrial ablation alone was applied solely in elderly patients with isolated aortic valve replacement. The left atrial appendage was closed from inside with 4–0 prolene double running sutures. The ligament of Marshall was divided during left pulmonary vein isolation and bilateral epicardial fats over the interatrial groove, comprised of ganglional plexi, were also resected. Left atrial volume reduction for markedly enlarged left atrium, dimensions > 60 mm by preoperative echo, was carried out with plications of posterior wall between the inferior pulmonary vein and mitral isthmus.


The Prognostic Scoring System Establishment and Validation for Chronic Atrial Fibrillation Patients Receiving Modified Cox-Maze IV and Concomitant Cardiac Surgery.

Tsai FC, Ho HT, Chang JP, Tsai FC, Chu JJ, Lin PJ - PLoS ONE (2015)

Lesion set of the modified Cox-maze IV procedure, Left atrium.1. Pulmonary veins isolation: Twice under beating heart. 2. Connect bilateral PV: Double line. 3. Connect to mitral annulus: Twice. 4. Connect LAA to LPV. 5. Suture closure of LAA: From interior, double layers. Additional procedures: divide ligament of Marshall; LA volume reduction. (PV: Pulmonary vein, LAA: Left atrial appendix, LPV: Left pulmonary vein, LA: Left atrium)
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465837&req=5

pone.0126300.g001: Lesion set of the modified Cox-maze IV procedure, Left atrium.1. Pulmonary veins isolation: Twice under beating heart. 2. Connect bilateral PV: Double line. 3. Connect to mitral annulus: Twice. 4. Connect LAA to LPV. 5. Suture closure of LAA: From interior, double layers. Additional procedures: divide ligament of Marshall; LA volume reduction. (PV: Pulmonary vein, LAA: Left atrial appendix, LPV: Left pulmonary vein, LA: Left atrium)
Mentions: Patients of the derivation group were operated on by three senior surgeons with technical unity and the first ten cases were excluded to avoid learning curve bias. Our routine approach was standard full sternotomy with bicaval cannulations, and AF ablation lesion sets were similar to traditional Cox-Maze III except most cut-and-sew lesions were replaced by the RF ablation device and separated pulmonary vein isolation with two connecting lesions of both superior and inferior pulmonary veins. [7] The complete lesion sets were as the Fig 1 and Fig 2. Additional cryoablation of mitral isthmus was applied with cryoprobe for 2 minutes. Bi-atrial ablation was applied in most cases and left atrial ablation alone was applied solely in elderly patients with isolated aortic valve replacement. The left atrial appendage was closed from inside with 4–0 prolene double running sutures. The ligament of Marshall was divided during left pulmonary vein isolation and bilateral epicardial fats over the interatrial groove, comprised of ganglional plexi, were also resected. Left atrial volume reduction for markedly enlarged left atrium, dimensions > 60 mm by preoperative echo, was carried out with plications of posterior wall between the inferior pulmonary vein and mitral isthmus.

Bottom Line: We try to establish a scoring system to predict the outcome of this procedure.The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively.In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University of Medicine, Kwei-Shan, Taoyuan, Taiwan; Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

ABSTRACT

Objectives: Traditional Cox maze III is the gold standard for treatment of atrial fibrillation (AF). Because of its invasiveness, it has been replaced by a simplified procedure involving radiofrequency ablation of modified Cox maze IV. Although the modified Cox maze IV has the advantages of simplicity and less morbidity, a lower rate of sinus rhythm conversion has been reported. We try to establish a scoring system to predict the outcome of this procedure.

Methods and results: The derivation group consisted of 287 patients with structural heart disease and chronic AF who underwent cardiac surgery and modified Cox-maze IV procedure between August 2005 and March 2013. Demographics, clinical and laboratory variables were retrospectively collected as sinus conversional predictors. Overall sinus conversion rate was 75.8%. The parameters of the Soft Markers Scoring system included AF duration, preoperative left atrial (LA) size, rheumatic pathology and postoperative LA remodeling. We compared 80 patients from another hospital between January 2004 and December 2011 as a validation group to evaluate the power of the scoring system. Soft Markers Score indicated a good discriminative power by using the areas under the receiver operating characteristic curve (AUROC: 0.759 ± 0.032). The score was further divided into three groups: low (0-2), intermediate (3-5), and high (6-10), with predicted sinus conversion rates of 92.4%, 74.2%, and 47.8%, respectively.

Conclusions: In patients with chronic AF receiving modified Cox-maze IV procedure, the Soft Markers Score demonstrated good discriminative power of predicting sinus recovery in our patients and applied well to the other validation populations.

No MeSH data available.


Related in: MedlinePlus