Posted by Carl Plaskett on February 26, 2003 at 20:54:42:
In Reply to: Re: Some maze questions posted by Ed Wehan on February 26, 2003 at 18:57:47:
I don't have the 1/2000 issue of "Seminars of Cardiothoracic Surgery", but I do have a copy of the 2/2000 "Operative Techniques in Thoracic and Cardiovascular Surgery-A Comparative Atlas" (Volume 5, Number 1), edited by James L. Cox, which was devoted to the Maze Procedure for Atril Fibrillation, as described by James L. Cox, Yoshio Kosakai, Roger C. Millar, Joseph M. Arcidi, Jr., and Patrick M. McCarthy. (This is ALSO an official publication of the American Association for Thoracic Surgery, AS IS the "Seminars in Thoracic and Cardiovascular Surgery").
Having just reviewed this issue, I don't find any specific reference to "atrial kick", but did find re-reading it to be interesting.
In the Introduction, Dr. Cox discussed the differences in procedures/results obtained by different surgeons, (with emphasis on Dr. Kosakai's different procedure). He goes on to say: "This is the type of operative technique controversy that we hoped to explore and clarify when this journal was founded. We trust that our readers will take the opportunity to review all of these articles and judge for themselves the best specific surgical technique to use when performing the Maze procedure for atrial fibrillation."
In MY opinion, this statement says it all about Dr. Cox' unselfish attitude about finding the best possible way to cure afib: He welcomed, and encouraged debate about the procedure he developed and pioneered. Even though he has retired from surgery, he is still active in improving the "cure". Afibbers now and in the future, will continue to reap the benefits of his tireless, career-long dedication to "curing" afib.
Dr. Cox, in his description of how the Maze morphed from the "Maze I" to the "Maze III", described two "unforeseen problems" with the Maze I, one of which was the resultant "prolonged intra-atrial conduction delay, which resulted in the sinus node impulse arriving in the left atrium at the same time it arrived in the left ventricle. This, in turn, resulted in apparent absence of left atrial contraction postoperatively because it was contracting at the same time as the left ventricle"
Perhaps this is what has been referred to as "atrial kick"? It might be interesting to find out WHO did the Maze on the patient referred to as having this problem, and WHEN the procedure was done. Since this was a problem with the first 32 patients (Maze I), and was modified for the next 15 patients (Maze II), that person might have been a Mazer more than "10 years ago". The Maze III has been in continuous use since 4/92, according to the above article. Hopefully, all surgeons performing the Maze since that date, have been doing the "gold standard" verion (Maze III).As an aside, Jack and I HAVE been known to call "mazers" both pre and post maze. Personally, I do it because I know what a morale boost it was for me to see Ed, out of the hospital on day four, in his room at the Guest House, smiling like a Cheshire Cat, on the day I arrived in Cleveland. That, and then seeing Mike Johnson, also smiling (but still at the CC), was all it took for me to "turn the corner" and dismiss any reservations about what I was about to experience. Without that "boost", I might have bolted from the CC and made up some story about why I didn't have the Maze. Thank God that I did not, for I would surely have been dead by now!
As Ed said, the CC "has seen it before" and problems are "old hat to them". Their success speaks volumes, (as does that of Dr. Millar, Dr. Barnes, and several other veteran Maze surgeons).
(Geeez, I posted two incredibly long posts today!)