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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 August;41(4):575-7

lingua: Inglese

How to spread out the satisfactory exposure: placement technique in right-sided maze procedure

Morishita A., Harada M., Watanabe M.

From the Depart­ment of Car­di­o­vas­cular Sur­gery Gunma ­Heart Insti­tute, ­Gunma, ­Japan


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We ­have, when­ever pos­sible, sub­sti­tuted cryoa­bla­tion for inci­sions in the ­maze pro­ce­dure. Cryoa­bla­tion ­helps pre­vent mas­sive ­bleeding ­because the ­number of resu­turing ­sites is ­reduced and ­aortic ­cross-­clamp ­time ­decreased. We are ­careful not to ­injure the ­atrio-ven­tric­ular con­duc­tion ­system ­during inci­sion at the ­side of the ­Koch tri­angle or cryoa­bla­tion ­while manip­u­lating the ­atrial ­septum. In ­prior ver­sions of the ­right-­sided ­maze pro­ce­dure, the IVC ­return can­nula has ­obstructed the sur­gical ­field ­approaching the IVC and the tri­cuspid ­valve ­annulus. ­This ­report ­describes a new mod­ifi­ca­tion of ­maze pro­ce­dure ­that ­includes ­changing the ­venous ­return ­site. We ­have ­obtained a sat­is­fac­tory sur­gical ­field ­without ­being ­afraid of the ana­tom­ical pit­fall, ­between the ­appendage and the tri­cuspid ­valve, and ­between the ­right cor­o­nary ­artery and the ­extended T inci­sion. We ­studied 12 ­patients (8 ­males and 4 ­females, ­mean age 61 ­years) who under­went the ­maze pro­ce­dure. ­Sinus ­rhythm was ­restored in 11 ­patients, ­whose clin­ical con­di­tion was ­improved to ­NYHA ­class I ­status. ­This tech­nique has ­proven effec­tive in ­obtaining sat­is­fac­tory expo­sure of the ­right ­atrium ­during the ­maze pro­ce­dure.

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