An Effective Modification to Simplify the Right Atrial Lesion Set of the Cox-Cryomaze

Cheema, Faisal H.; Younus, Muhammad Amir; Pasha, Arham; Cox, James L.; Roberts, Harold G.

doi:10.1016/j.athoracsur.2012.12.065

Cited by 16 publications

(12 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All 50 patients were operated using the Mexican modification for the Cox-maze III procedure, described by García-Villarreal, 7 or any of its variants for cases of difficult access to the LA. 8 It is important noting that, since 2015, we modified the lesion pattern on the right atrium: 9 only one counter-lesion is used on the tricuspid ring in the position that corresponds to two o'clock in the hands of the clock, while another T-incision is made from the transverse incision in the right atrium, 1.5 to 2.5 cm outside the right atrioventricular groove and it is prolonged until reaching the tip of the right appendage. In no case was there any cryoablation lesion used on the external face of the coronary sinus on the line of the mitral isthmus, given that this alternative energy source was not available.…”

Section: Methodsmentioning

confidence: 99%

Long-term effectiveness of the Cox-maze III procedure and its relationship with left atrial postoperative size

García-Villarreal¹

2023

GMM

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Long-term effectiveness of the Cox-maze III procedure and its relationship with left atrial postoperative size

García-Villarreal¹

2023

GMM

View full text Add to dashboard Cite

show abstract

“…La totalidad de los 50 pacientes fueron operados utilizando la modificación mexicana para el procedimiento de Cox-maze III, descrita por García-Villarreal, 7 o alguna de sus variantes para los casos de difícil acceso a la AI. 8 Es importante destacar que a partir de 2015 hemos modificado el patrón de lesiones sobre la aurícula derecha: 9 se utiliza solo una contralesión sobre el anillo tricúspideo en la posición que corresponde a las dos en las manecillas del reloj, a la vez que se realiza otra incisión en T desde la incisión transversal en la aurícula derecha, de 1.5 a 2.5 cm afuera del surco auriculoventricular derecho y se prolonga hasta alcanzar la punta de la orejuela derecha. En ningún caso se utilizó criolesión sobre la cara externa del seno coronario en la línea del istmo mitral, por no contar con esta fuente de energía alternativa.…”

Section: Métodounclassified

Efectividad del procedimiento de Cox-maze III a largo plazo y su relación con el tamaño posoperatorio de la aurícula izquierda

García-Villarreal

2019

GMM

View full text Add to dashboard Cite

Introducción: El procedimiento de Cox-maze III está diseñado para eliminar la fibrilación auricular. Objetivo: Determinar la relación del tamaño posoperatorio de aurículas izquierdas en las que se realizó procedimiento de Cox-maze III. Método: De julio de 2012 a abril de 2016 se operó a 50 pacientes con enfermedad mitral primaria y fibrilación auricular concomitante. Se utilizó Cox-maze III mediante "corte y sutura" biatrial completo. La duración preoperatoria de la fibrilación auricular fue de 3.5 ± 2.1 años. Resultados: No hubo mortalidad operatoria. La ausencia de fibrilación auricular fue de 92, 88 y 73.7 % a tres meses, uno y tres años. Se encontró́ relación directa entre el tamaño posoperatorio de la aurícula izquierda y la probabilidad de falla del Cox-maze cuando la aurícula izquierda fue > 6.5 cm a un año (RR = 10.5, IC 95 % = 4.30-26.67, p < 0.0001) y a tres años (RR = 27.1, p = 0.0009). El tamaño de la aurícula izquierda disminuyó de 7.1 ± 0.5 cm a 6.2 ± 0.5 cm (p < 0.0001). Conclusiones: El Cox-maze III es eficaz para eliminar la fibrilación auricular asociada con enfermedad mitral cuando el tamaño posoperatorio de la aurícula izquierda es ≤ 6.5 cm.

show abstract

“…This lesion pattern was initially suggested to us by Cox and had been previously reported by our group. 5 It replaced the so-called counter lesion in the standard Cox-Maze III procedure. The "counter lesion" is in fact the 10-o'clock lesion that mirrors the 2-o'clock lesion on the posterior tricuspid annulus.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Subsequent to our earlier publication 5 -demonstrating an effective alternative ( Fig. 1) to this particular lesion, many surgeons have anecdotally embraced this modified right atrial lesion (RAL) technique.…”

mentioning

confidence: 99%

Early Results of the Modified Right Atrial Lesion Set for the Cox-Cryomaze Procedure

Cheema

Siddiqui

Younus

et al. 2016

Innovations�(Phila)

Self Cite

View full text Add to dashboard Cite

Objective The standard right atrial lesion (RAL) set, as originally outlined in the Cox-Maze III procedure, can be technically challenging when using a cryoprobe to create the lesions. We report our initial experience with an alternative set of RALs for the surgical treatment of atrial fibrillation (AF). Methods Between September 2011 and January 2015, a total of 112 patients underwent a CryoMaze procedure with biatrial lesions using argon-based cryoablation (cryoprobe temperature, −160°C). Although the standard left atrial lesion set was used, the RAL pattern was modified in this cohort of patients. The intracaval superior vena cava-inferior vena cava lesion was performed as in the pattern described for the standard Cox-Maze III procedure. In addition, a horizontal atriotomy incision (the “T” lesion) in the mid free wall of the right atrium was based roughly in the midintercaval line and extended medially as a linear cryolesion to the lateral tricuspid annulus at the so-called 2-o'clock position as in the Cox-Maze III lesion pattern. Ordinarily, a linear cryolesion would be placed from the tip of the right atrial appendage (RAA) to the anterior tricuspid annulus at the so-called 10-o'clock position to prevent macro re-entry around the base of the RA appendage. Our modification consisted of, instead, a linear cryolesion directed perpendicularly from the mid portion of the atriotomy (T lesion) to the tip of the RA appendage, which simply interrupted RAA re-entry at another point. Results The mean ± standard deviation age was 72.7 ± 10.6 years, 56.3% were males, and 63.1% had long-standing persistent AF. There were three operative deaths (2.6% with an observed over expected of 0.58), all in the concomitant procedures with associated cardiac disease. Overall follow-up was 91.3%. Freedom from AF at discharge, 1-, 3-, 6-, 12-, 24-month, and last follow-up [16.1 ±11.3 months (range, 0.4–43 months)], was 100%, 76.3%, 84.2%, 98.3%, 89.5%, 89.2%, and 90.5%, respectively. Similarly, freedom from antiarrhythmic drugs was 74% and 81%, whereas freedom from anticoagulants was 72% and 78% at 12 and 24 months, respectively. Conclusions These results suggest the modified RAL set to be an effective alternative to the traditional RALs of Cox-Maze III. By substituting this lateral RAA lesion for the more technically difficult medial lesion, the procedure becomes easier to perform and favorably impacts operative time while achieving comparable results in reducing AF burden.

show abstract

An Effective Modification to Simplify the Right Atrial Lesion Set of the Cox-Cryomaze

Cited by 16 publications

References 4 publications

Long-term effectiveness of the Cox-maze III procedure and its relationship with left atrial postoperative size

Long-term effectiveness of the Cox-maze III procedure and its relationship with left atrial postoperative size

Efectividad del procedimiento de Cox-maze III a largo plazo y su relación con el tamaño posoperatorio de la aurícula izquierda

Early Results of the Modified Right Atrial Lesion Set for the Cox-Cryomaze Procedure

Contact Info

Product

Resources

About