ObjectiveTo analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery.MethodsWe retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram.ResultsNo death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively.ConclusionConcomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is known to be associated with stroke, dementia, heart failure, and increased mortality. For patients with drug-refractory AF, ablation therapy using surgical or catheter-based techniques is recommended. In the evolution of surgical AF treatment, the Maze Ⅲ procedure marked a significant milestone as the first surgical approach to achieve a high success rate in restoring sinus rhythm. However, due to its technical complexity and demanding requirements, researchers have extensively modified the technique using innovative approaches, leading to the development of new surgical ablation methods, including the Maze Ⅳ procedure, minimally invasive Maze Ⅳ surgery, and hybrid ablation techniques. This review focuses on these surgical treatment strategies and discusses the latest research advancements in the field.