The effect of ablation technology on surgical outcomes after the Cox-maze procedure: A propensity analysis

Shelly C. Lall, Spencer J. Melby, Rochus K. Voeller, Andreas Zierer, Marci S. Bailey, Tracey J. Guthrie, Marc R. Moon, Nader Moazami, Jennifer Lawton, Ralph J. Damiano

Research output: Contribution to journalArticle

Abstract

Objectives: Since its introduction in 1987, the Cox-maze procedure has been the gold standard for the surgical treatment of atrial fibrillation. At our institution, this procedure has evolved from the cut-and-sew technique (Cox-maze III procedure) to one using bipolar radiofrequency energy and cryoablation as ablative sources to replace most incisions (Cox-maze IV procedure). This study compared surgical outcomes of patients undergoing the Cox-maze III procedure versus those of patients undergoing the Cox-maze IV procedure by using propensity analysis. Methods: From April 1992 through July 2005, 242 patients underwent the Cox-maze procedure for atrial fibrillation. Of these, 154 patients had the Cox-maze III procedure, and 88 had the Cox-maze IV procedure. Logistic regression analysis was used to identify covariates among 7 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 58 patients each. Operative outcomes were analyzed for differences. Late follow-up was available for 112 (97%) patients. Freedom from atrial fibrillation recurrence and survival was calculated at 1 year by using Kaplan-Meier analysis. Results: The Cox-maze III procedure had significantly longer crossclamp times. There was no significant difference in intensive care unit and hospital stay, 30-day mortality, permanent pacemaker placement, early atrial tachyarrhythmias, late stroke, and survival. Freedom from atrial fibrillation recurrence was greater than 90% in both groups at 1 year. Conclusions: The use of bipolar radiofrequency ablation has simplified the Cox-maze procedure, making it applicable to virtually all patients with atrial fibrillation undergoing concomitant cardiac surgery. The Cox-maze IV procedure produces similar surgical outcomes to the Cox-maze III procedure at 1 year of follow-up.

Original languageEnglish (US)
Pages (from-to)389-396
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume133
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

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Technology
Atrial Fibrillation
Recurrence
Propensity Score
Cryosurgery
Survival
Kaplan-Meier Estimate
Tachycardia
Thoracic Surgery
Intensive Care Units
Length of Stay
Logistic Models
Stroke
Regression Analysis
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lall, S. C., Melby, S. J., Voeller, R. K., Zierer, A., Bailey, M. S., Guthrie, T. J., ... Damiano, R. J. (2007). The effect of ablation technology on surgical outcomes after the Cox-maze procedure: A propensity analysis. Journal of Thoracic and Cardiovascular Surgery, 133(2), 389-396. https://doi.org/10.1016/j.jtcvs.2006.10.009

The effect of ablation technology on surgical outcomes after the Cox-maze procedure : A propensity analysis. / Lall, Shelly C.; Melby, Spencer J.; Voeller, Rochus K.; Zierer, Andreas; Bailey, Marci S.; Guthrie, Tracey J.; Moon, Marc R.; Moazami, Nader; Lawton, Jennifer; Damiano, Ralph J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 2, 02.2007, p. 389-396.

Research output: Contribution to journalArticle

Lall, SC, Melby, SJ, Voeller, RK, Zierer, A, Bailey, MS, Guthrie, TJ, Moon, MR, Moazami, N, Lawton, J & Damiano, RJ 2007, 'The effect of ablation technology on surgical outcomes after the Cox-maze procedure: A propensity analysis', Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 2, pp. 389-396. https://doi.org/10.1016/j.jtcvs.2006.10.009
Lall, Shelly C. ; Melby, Spencer J. ; Voeller, Rochus K. ; Zierer, Andreas ; Bailey, Marci S. ; Guthrie, Tracey J. ; Moon, Marc R. ; Moazami, Nader ; Lawton, Jennifer ; Damiano, Ralph J. / The effect of ablation technology on surgical outcomes after the Cox-maze procedure : A propensity analysis. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 133, No. 2. pp. 389-396.
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abstract = "Objectives: Since its introduction in 1987, the Cox-maze procedure has been the gold standard for the surgical treatment of atrial fibrillation. At our institution, this procedure has evolved from the cut-and-sew technique (Cox-maze III procedure) to one using bipolar radiofrequency energy and cryoablation as ablative sources to replace most incisions (Cox-maze IV procedure). This study compared surgical outcomes of patients undergoing the Cox-maze III procedure versus those of patients undergoing the Cox-maze IV procedure by using propensity analysis. Methods: From April 1992 through July 2005, 242 patients underwent the Cox-maze procedure for atrial fibrillation. Of these, 154 patients had the Cox-maze III procedure, and 88 had the Cox-maze IV procedure. Logistic regression analysis was used to identify covariates among 7 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 58 patients each. Operative outcomes were analyzed for differences. Late follow-up was available for 112 (97{\%}) patients. Freedom from atrial fibrillation recurrence and survival was calculated at 1 year by using Kaplan-Meier analysis. Results: The Cox-maze III procedure had significantly longer crossclamp times. There was no significant difference in intensive care unit and hospital stay, 30-day mortality, permanent pacemaker placement, early atrial tachyarrhythmias, late stroke, and survival. Freedom from atrial fibrillation recurrence was greater than 90{\%} in both groups at 1 year. Conclusions: The use of bipolar radiofrequency ablation has simplified the Cox-maze procedure, making it applicable to virtually all patients with atrial fibrillation undergoing concomitant cardiac surgery. The Cox-maze IV procedure produces similar surgical outcomes to the Cox-maze III procedure at 1 year of follow-up.",
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T1 - The effect of ablation technology on surgical outcomes after the Cox-maze procedure

T2 - A propensity analysis

AU - Lall, Shelly C.

AU - Melby, Spencer J.

AU - Voeller, Rochus K.

AU - Zierer, Andreas

AU - Bailey, Marci S.

AU - Guthrie, Tracey J.

AU - Moon, Marc R.

AU - Moazami, Nader

AU - Lawton, Jennifer

AU - Damiano, Ralph J.

PY - 2007/2

Y1 - 2007/2

N2 - Objectives: Since its introduction in 1987, the Cox-maze procedure has been the gold standard for the surgical treatment of atrial fibrillation. At our institution, this procedure has evolved from the cut-and-sew technique (Cox-maze III procedure) to one using bipolar radiofrequency energy and cryoablation as ablative sources to replace most incisions (Cox-maze IV procedure). This study compared surgical outcomes of patients undergoing the Cox-maze III procedure versus those of patients undergoing the Cox-maze IV procedure by using propensity analysis. Methods: From April 1992 through July 2005, 242 patients underwent the Cox-maze procedure for atrial fibrillation. Of these, 154 patients had the Cox-maze III procedure, and 88 had the Cox-maze IV procedure. Logistic regression analysis was used to identify covariates among 7 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 58 patients each. Operative outcomes were analyzed for differences. Late follow-up was available for 112 (97%) patients. Freedom from atrial fibrillation recurrence and survival was calculated at 1 year by using Kaplan-Meier analysis. Results: The Cox-maze III procedure had significantly longer crossclamp times. There was no significant difference in intensive care unit and hospital stay, 30-day mortality, permanent pacemaker placement, early atrial tachyarrhythmias, late stroke, and survival. Freedom from atrial fibrillation recurrence was greater than 90% in both groups at 1 year. Conclusions: The use of bipolar radiofrequency ablation has simplified the Cox-maze procedure, making it applicable to virtually all patients with atrial fibrillation undergoing concomitant cardiac surgery. The Cox-maze IV procedure produces similar surgical outcomes to the Cox-maze III procedure at 1 year of follow-up.

AB - Objectives: Since its introduction in 1987, the Cox-maze procedure has been the gold standard for the surgical treatment of atrial fibrillation. At our institution, this procedure has evolved from the cut-and-sew technique (Cox-maze III procedure) to one using bipolar radiofrequency energy and cryoablation as ablative sources to replace most incisions (Cox-maze IV procedure). This study compared surgical outcomes of patients undergoing the Cox-maze III procedure versus those of patients undergoing the Cox-maze IV procedure by using propensity analysis. Methods: From April 1992 through July 2005, 242 patients underwent the Cox-maze procedure for atrial fibrillation. Of these, 154 patients had the Cox-maze III procedure, and 88 had the Cox-maze IV procedure. Logistic regression analysis was used to identify covariates among 7 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 58 patients each. Operative outcomes were analyzed for differences. Late follow-up was available for 112 (97%) patients. Freedom from atrial fibrillation recurrence and survival was calculated at 1 year by using Kaplan-Meier analysis. Results: The Cox-maze III procedure had significantly longer crossclamp times. There was no significant difference in intensive care unit and hospital stay, 30-day mortality, permanent pacemaker placement, early atrial tachyarrhythmias, late stroke, and survival. Freedom from atrial fibrillation recurrence was greater than 90% in both groups at 1 year. Conclusions: The use of bipolar radiofrequency ablation has simplified the Cox-maze procedure, making it applicable to virtually all patients with atrial fibrillation undergoing concomitant cardiac surgery. The Cox-maze IV procedure produces similar surgical outcomes to the Cox-maze III procedure at 1 year of follow-up.

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