The concomitant cryosurgical Cox-Maze procedure using Argon based cryoprobes: 12 month results

The cut and sew Cox-Maze III procedure has proven to be extremely effective in curing atrial fibrillation. Due to the relative complexity various procedures were developed to apply ablative lesions to treat atrial fibrillation using different energy sources. In this report we present data related to our experience with Argon based cryoablation system in patients having first time concomitant CryoCox-Maze III procedure and other cardiac surgical procedures.

This is a prospective study where all patients undergoing the Cox maze procedure are entered into our unique maze registry and are followed at 3, 6, 12, 18, 24 months and yearly thereafter. Health related quality of life (SF-12) and atrial fibrillation frequency and severity of symptoms were obtained preoperatively and at follow up. Rhythm was verified by EKG and 24 hour holter. The Heart Rhythm Society definition of failure (any monitored incident of an atrial arrhythmia >30 seconds) was used to compute the rate of return to sinus rhythm. The ablative technique employed was argon based crytothermia using only 1 to 2 atriotomies.

The total number of patients operated by multiple surgeons was 124 with 17% through a right minithoracotomy. The operative mortality (<2%) and perioperative stroke rate (<1%) were very low. At 12 months 87% of the patients were in sinus rhythm and off class I and III antriarrhythmic drugs. There was a clear difference in success rate depending on surgeon's total experience. Quality of life and severity of symptoms were improved significantly.

The one year results of the CryoCox-Maze III procedure when performed concomitantly with another cardiac surgical procedure demonstrate reasonable safety and efficacy. However, operator experience may be related to better outcome. The ablation of atrial fibrillation may be associated with improved quality of life and symptoms relief.