The ABLATE Trial: Safety and Efficacy of Cox Maze-IV Using a Bipolar Radiofrequency Ablation System

Philpott, Jonathan M.; Zemlin, Christian W.; Cox, James L.; Stirling, Mack C.; Mack, Michael J.; Hooker, Robert L.; Morris, Allen; Heimansohn, David; Longoria, James; Gandhi, Divyakant; McCarthy, Patrick M.

doi:10.1016/j.athoracsur.2015.07.006

Cited by 41 publications

(43 citation statements)

References 15 publications

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“…Previous studies have demonstrated that successful SR restoration improved survival of stroke. 34,36 However, interestingly, our PSM analysis shows that in the nonablated group, stroke survival was similar to those in ablated patients. Remarkably, in both groups, nearly 90% of patients underwent mechanical MV replacement, which entailed chronic anticoagulation therapy.…”

Section: Discussionsupporting

confidence: 50%

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Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right‐Sided Heart Remodeling After Mitral‐Valve Surgery: A Propensity‐Score Matching Analysis

Wang

Han

et al. 2016

JAHA

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BackgroundThis study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right‐sided heart remodeling in patients after mitral valve procedure.Methods and ResultsBetween 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity‐score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate‐to‐severe TR, as well as echocardiography indices in long‐term follow‐up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081–2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299–5.466; P=0.008), and moderate‐to‐severe TR (HR, 1.436; 95% CI, 1.059–1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right‐sided heart remodeling after 5‐year follow‐up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5‐year follow‐up. The recurrent group showed significantly higher risks of moderate‐to‐severe TR (HR, 2.427; 95% CI, 1.261–4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right‐sided heart remodeling.ConclusionsIn a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right‐sided heart remodeling, which are alleviated by surgical ablation.

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Section: Discussionsupporting

confidence: 50%

“…Previous studies have demonstrated that successful SR restoration improved survival of stroke . However, interestingly, our PSM analysis shows that in the nonablated group, stroke survival was similar to those in ablated patients.…”

Section: Discussionsupporting

confidence: 42%

Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right‐Sided Heart Remodeling After Mitral‐Valve Surgery: A Propensity‐Score Matching Analysis

Wang

Han

et al. 2016

JAHA

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“…Early success with concomitant AF ablation associated with non-HCM aortic valve disease and mitral valve disease is above 75% in the absence of the classical risk factors for poor prognosis (age beyond 75, LA Diameter over 50 mm, duration of AF more than 5 years and non-paroxysmal AF) (13,14). For concomitant AF ablative surgery, outcomes with the classic Maze III lesion pattern (either cut-and-sew or cryoablation) can be expected to be superior to those achieved with "modifications" of the original lesion set (15,16). When using the original lesion pattern, the long-term success rate did not vary on the basis of the classic predictors of failure (15,17).…”

Section: Clinical Outcomes Associated With Af and Hcmmentioning

confidence: 99%

Surgical management of atrial fibrillation at the time of septal myectomy

Cox

2017

Ann. Cardiothorac. Surg.

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Atrial fibrillation (AF) may appear during the natural clinical course of hypertrophic cardiomyopathy (HCM).It is regarded as a complication of HCM and is a marker of advanced disease. AF is more likely to occur in untreated, obstructive HCM. Unfortunately, this represents a turning point that puts patients at increased risk of further disability, stroke and death. The presence of obstruction is an indication to proceed with septal myectomy to improve or resolve symptoms by ameliorating diastolic dysfunction. If the patient has concomitant AF, a Maze procedure should be added to the septal myectomy. This combined operation yields excellent hemodynamic benefits and potentially decreases the risk of thromboembolic events.

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“…There were questions about effectiveness; these were answered by numerous studies demonstrating that application of the Cox maze procedure substantially increases the likelihood of return to sinus rhythm. 4,5 Concerns regarding safety and prolonged pump times were addressed by the development of alternate energy sources and studies confirming their safe application. 4,5 More recently, large observational studies suggest that the Cox maze procedure may be associated with improved short-and long-term survival.…”

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confidence: 99%