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Cox/maze procedure for atrial septal defect with atrial fibrillation: management strategies
L I Bonchek1, M W Burlingame, S J Worley
1Lancaster General Hospital, Pennsylvania.
Insights
Atrial fibrillation (AF) is common after atrial septal defect (ASD) repair. Combining ASD correction with the Cox/maze procedure may eliminate AF and its associated risks in select adults.
Area of Science:
- Cardiovascular Surgery
- Electrophysiology
- Adult Congenital Heart Disease
Background:
- Atrial septal defect (ASD) is a congenital heart defect often corrected surgically.
- Postoperative atrial fibrillation (AF) occurs in about 50% of adults after ASD repair, increasing stroke risk.
- Current management involves monitoring and treating AF, often with chronic medication.
Observation:
- A 52-year-old male patient with ASD underwent simultaneous surgical correction of both the defect and AF.
- The Cox/maze procedure was employed for the combined surgical approach.
- The patient tolerated the combined procedure well.
Findings:
- Simultaneous surgical correction of ASD and AF was successfully achieved.
- This combined approach offers a potential solution to prevent or treat AF in adults undergoing ASD repair.
- The procedure demonstrated a low added risk with significant benefit.
Implications:
- Consideration of simultaneous Cox/maze procedure during ASD repair in selected adult patients may be warranted.
- This strategy could reduce long-term AF-related complications, including stroke and the need for chronic drug therapy.
- Further research into the long-term efficacy and patient selection for this combined approach is suggested.
Abstract:
Atrial fibrillation is found at late follow-up in approximately half of all adults who have had correction of atrial septal defect, even if it was not present preoperatively. These patients are thus exposed to the risks of stroke and chronic drug therapy even after a successful operation. Simultaneous surgical correction of atrial septal defect and atrial fibrillation was accomplished in a 52-year-old man by means of the Cox/maze procedure. The small added risk and the substantial benefit of eliminating atrial fibrillation suggest that this approach is warranted in selected adults with atrial septal defect.