Maze procedure in single ventricle patients

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.
• 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.