[HSF] Indications for maze with mitral surgery

[Hgrmd at aol.com]

Prasanna,
  It's a little hard to follow, but your lesion set is not the same as  the 
one described in the Cox-maze III.  It doesn't contain a cavo-tricuspid  
isthmus lesion.  Around '03, at an AF symposium at the STS in San Antonio,  Dr. Cox 
publicly stated that he felt that the right atrial flutter line  
(cavo-tricuspid isthmus) was all that was probably necessary for the right  side.  He has 
since reneged and stated that a full set of right sided  lesions is necessary.  
I recently reminded him of what he said, and he  stated that he didn't think 
it would make a huge difference either way.   Regardless, I jumped on what he 
said back then and just started doing just the  flutter line for the right 
side.  
  I do the flutter line after I release the clamp, i.e., the heart is  warm 
and beating.  A few times I've noticed before making the flutter line  that the 
atrium is in flutter.  Within 20 seconds of applying Cryocath  along the 
cavo-tricuspid isthmus, the heart will convert to NSR.  It's fun  to observe.
  I'm presenting my results in 180 patients in a poster at ISMICS this  June. 
 With over 2/3's in continuous AF, the success rate is in the  90's.
 
Hal



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