A novel atrial volume reduction technique to enhance the Cox maze procedure: Initial results Akira Marui, MD, PhD, Takeshi Nishina, MD, PhD, Keiichi.

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A novel atrial volume reduction technique to enhance the Cox maze procedure: Initial results Akira Marui, MD, PhD, Takeshi Nishina, MD, PhD, Keiichi Tambara, MD, PhD, Yoshiaki Saji, MD, Takeshi Shimamoto, MD, Masahiko Nishioka, MD, Tadashi Ikeda, MD, PhD, Masashi Komeda, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 5, Pages 1047-1053 (November 2006) DOI: 10.1016/j.jtcvs.2006.07.020 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Concept of the less-invasive volume reduction technique by means of left atrial plication and confinement cryoablation. A, Areas for left atrial volume reduction: (a) main area, the redundant left atrial wall between the mitral annulus and the left pulmonary veins; (b) additional area, the left atrial wall along the right-sided left atriotomy. B, Plication of the left atrium. The redundant left atrial area was not excised but plicated toward the outside of the left atrial cavity (anatomic isolation). C, Electrical isolation of the plicated area by means of confinement cryoablation. Cryoablation was applied onto the horizontal mattress suture line (electrical isolation), and then the anatomic and electrical isolation of the plicated area (confinement) was completed. LA, Left atrium; LV, left ventricle; PV, pulmonary vein; VR, volume reduction. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1047-1053DOI: (10.1016/j.jtcvs.2006.07.020) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The Cox maze procedure with the volume reduction technique. The redundant left atrial wall between the mitral annulus and the left pulmonary veins was plicated with continuous horizontal mattress sutures (anatomic isolation). Then the plicated area was isolated by means of confinement cryoablation along the suture line (electrical isolation). LAA, Left atrial appendage; SVC, superior vena cava; IVC, inferior vena cava; FO, foramen ovale; SN, sinus node; CS, coronary sinus; MV, mitral valve; TV, tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1047-1053DOI: (10.1016/j.jtcvs.2006.07.020) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Representative echocardiographic findings of the volume reduction Cox maze procedure. Preoperative and postoperative echocardiographic findings of a 50-year-old woman with the volume reduction Cox maze procedure are shown. The left atrium was severely enlarged preoperatively (left atrial diameter, 76 mm); however, the diameter was considerably reduced to 46 mm by using the volume reduction Cox maze procedure, and the rhythm was converted to sinus rhythm. Upper (lower) panels, Transesophageal (transthoracic) echocardiography. Asterisks, left atrial plicated area. LA, Left atrium; Ao, aorta; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1047-1053DOI: (10.1016/j.jtcvs.2006.07.020) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions