In this review the efficacies of the alternative sources of energy (radiofrequency-microwave and cryo ablation; group I) and the classical 'cut and sew' Cox-Maze III (group II), which claims a 97-99% sinus rhythm (SR) success rate, were evaluated in the surgical treatment of atrial fibrillation (AF). A computerized search in the PubMed and Medline database was conducted. Only original, English written, clinical manuscripts on the surgical treatment of atrial fibrillation using an alternative source of energy or the classical 'cut and sew' Cox-Maze III technique, citing the clinical outcome, including the postoperative sinus rhythm, were included. The data included in this review were the number and percentage of treated patients, gender distribution, the type of arrhythmia and surgery, postoperative morbidity, pacemaker implantation rate, 30-day mortality, survival- and sinus rhythm conversion rates. Mean values for age, left atrial diameter, preoperative duration of AF and left ventricular ejection fraction were also recorded. Forty-eight studies were included comprising 3832 patients; 2279 in group I and 1553 in group II. The mean duration of AF, left atrial diameter and LVEF were 5.4 vs. 5.5 years (p=0.90), 55.5 vs. 57.8 mm (p=0.23) and 57 vs. 58% (p= 0.63). The postoperative SR rates for group I and II were 78.3 vs. 84.9% (p=0.03). However, the "cut and sew" Cox-Maze III was conducted in younger patients (55.0 vs. 61.2 years; p=0.005), more often to treat paroxysmal (22.9 vs. 8.0%; p=0.05) and lone AF (19.3 vs. 1.6%). Alternative sources of energy were predominantly used to treat permanent AF (92.0%), almost always as a concomitant surgical procedure (98.4%) and increasingly in combination with non-mitral valve surgery (18.5%). After correction for these variations, the postoperative SR conversion rates for group I and II did not differ significantly anymore (p=0.260). Conclusions: We could not identify any significant difference in the postoperative SR conversion rates between the classical 'cut and sew' and the alternative sources of energy, which were used to treat atrial fibrillation.

/pdf/surgical-treatment-of-atrial-fibrillation-a-systematic-428xnbm51j.pdf

Surgical treatment of atrial fibrillation; a systematic review.

A cryoplasty catheter and method for preventing or slowing reclosure of a lesion following angioplasty. The cryoplasty catheter includes a shaft having proximal and distal ends and a dilatation balloon disposed at the distal end. An intake lumen and exhaust lumen are defined by the shaft to deliver coolant to the balloon and to exhaust or drain coolant from the balloon. The method in accordance with the present invention includes cooling a lesion to aid in remodeling the lesion through dilatation and/or freezing a portion of the lesion adjacent the dilatation balloon to kill cells within the lesion to prevent or retard restenosis.

Cryoplasty device and method

Surgical ablation as treatment for the elimination of atrial fibrillation: A meta-analysis

The present invention pertains generally to the field of cryo balloon therapy and the use of cryo balloon therapy catheters to generate cold-induced lesions. The present invention includes a cryo balloon therapy apparatus, comprising a catheter having a proximal and a distal end, a cooling member disposed at the distal end of the catheter, a pull cord coupled to the cooling member, and a sheath that couples the pull cord and the catheter. A method for causing cold-induced necrosis is also disclosed.

Cryo balloon for atrial ablation

Devices and methods for cooling vessel walls to inhibit restenosis in conjunction with medical procedures such as coronary artery angioplasty. Stenosed vessel walls can be cooled prior to angioplasty, after angioplasty, or both. The invention is believed to inhibit restenosis through cooling to a temperature near freezing, preferably without causing substantial vessel wall cell death. One catheter device includes a distal tube region having coolant delivery holes radially and longitudinally distributed along the distal region. In some devices, holes spray coolant directly onto the vessel walls, with the coolant absorbed into the blood stream. In other embodiments, a balloon or envelope is interposed between the coolant and the vessel walls and the coolant returned out of the catheter through a coolant return lumen. Some direct spray devices include an occlusion device to restrict blood flow past the region being cooled. Pressure, temperature, and ultrasonic probes are included in some cooling catheters. Pressure control valves are included in some devices to regulate balloon interior pressure within acceptable limits. In applications using liquid carbon dioxide as coolant, the balloon interior pressure can be maintained above the triple point of carbon dioxide to inhibit dry ice formation. Some cooling catheters are coiled perfusion catheters supporting longer cooling periods by allowing perfusing blood flow simultaneously with vessel wall cooling. One coiled catheter is biased to assume a coiled shape when unconstrained and can be introduced into the body in a relatively straight shape, having a stiffening wire inserted through the coil strands.

Cryotreatment device and method

https://www.annalsthoracicsurgery.org/article/0003-4975(95)00314-B/pdf

Cox maze operation without cryoablation for the treatment of chronic atrial fibrillation

https://www.annalsthoracicsurgery.org/article/S0003-4975(99)00850-4/pdf

Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae

Preliminary results with a new technique for repairing elongated chordae tendineae of the anterior mitral valve leaflet

Seis pacientes foram submetidos ao tratamento cirurgico da fibrilacao atrial (FA) pela tecnica do labirinto (Cox), sem a uitilizacao da crioblacao. Quatro pacientes apresentavam estenose mitral (EM) associada, 1 insuficiencia mitral e 1 dupla lesao mitral. Um dos pacientes apresentava estenose tricuspide e 2 insuficienciatricuspide associadas. O diâmetro medio do atrio esquerdo, medido pelo ecocardiograma era de 6,0 cm (5-7,3). A etiologia era reumatica em 5 pacientes e degenerativa em 1. Plastia valvar mitral foi realizada em 3 pacientes, comissurotomia mitral em 2 e troca valvar mitral em 1. Em 4 pacientes havia trombos no atrio esquerdo, um deles tambem no atrio direito. O tempo medio de circulacao extracorporea foi de 123 minutos (110-142) e de anoxia do miocardio de 91 minutos (80-108). Na sala de operacoes o ritmo inicial era juncional em 4 e sinusal em 2. No pos-operatorio imediato, todos apresentavam ritmo juncional, passando para ritmo sinusal em todos, exceto em 1. Os pacientes receberam alta hospitalar (8-27 dias) em boas condicoes, sem utilizacao de drogas antiarritmicas e o Holter de 24 horas mostrava ritmo sinusal em 5 pacientes e ritmo atrial ectopico em 1 paciente. O estudo hemodinâmico e o ecodoppler revelaram contracao atrial sincronica em todos os casos, exceto em 1. O diâmetro atrial esquerdo medio era de 4,8 cm (3,7 - 5,2).

http://www.scielo.br/pdf/rbccv/v8n3/v8n3a06.pdf

Silva Ss

Papers

Cox maze operation without cryoablation for the treatment of chronic atrial fibrillation

Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae

Preliminary results with a new technique for repairing elongated chordae tendineae of the anterior mitral valve leaflet

Técnica de Cox sem crioablação para tratamento cirúrgico da fibrilação atrial

Grafting of chordae tendineae: A new technique for the repair of mitral insufficiency caused by ruptured chordae of the anterior leaflet