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Maze procedure in single ventricle patients.

Carl Lewis Backer1, Sabrina Tsao, Barbara J Deal

  • 1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. cbacker@childrensmemorial.org

Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
|April 9, 2008
PubMed
Summary

This study details a cryocatheter maze strategy for arrhythmias in Fontan conversion patients. The procedure shows high success rates for treating atrial reentry tachycardia and atrial fibrillation, with low mortality.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Electrophysiology

Background:

  • Fontan conversion procedures are performed in patients with single-ventricle physiology.
  • Arrhythmias, including atrial reentry tachycardia and atrial fibrillation, are common indications for surgery in these patients.
  • Existing surgical treatments for these arrhythmias include the modified right atrial maze and Cox-maze III procedures.

Purpose of the Study:

  • To describe the strategy for performing maze procedures in single-ventricle patients undergoing Fontan conversion.
  • To evaluate the efficacy and safety of a specific maze technique in this patient population.

Main Methods:

  • A modified maze procedure utilizing a cryocatheter with cryoablation at -160°C for 1 minute.
  • Lesions created by cryoablation were combined with standard surgical incisions in the right and left atria.

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  • The study reviewed data from 120 patients who underwent Fontan conversion with this maze strategy.

    • Main Results:

    • Early mortality was 1%, and late mortality was 5%.
    • Freedom from atrial reentry tachycardia recurrence at 5 years was 86%.
    • Freedom from atrial fibrillation recurrence at 5 years was 98%.

    Conclusions:

    • The cryocatheter-based maze procedure is an effective strategy for managing arrhythmias in single-ventricle patients undergoing Fontan conversion.
    • This technique demonstrates favorable long-term outcomes regarding arrhythmia recurrence and survival.
    • The combined approach of cryoablation and surgical incisions offers a viable treatment option for complex arrhythmias in this challenging patient group.