The Cox maze III procedure: Parallel normalization of sinus node dysfunction, improvement of atrial function, and recovery of the cardiac autonomic nervous system

M. Pasic, M. Musci, H. Siniawski, O. Grauhan, B. Edelmann, T. Tedoriya, Y. Weng, R. Hetzer, J. L. Cox, Hartzell V Schaff

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: The Cox maze HI procedure includes isolation of the pulmonary veins and multiple incisions in both atria in what corresponds to partial autotransplantation and partial denervation of the heart. The aim of this prospective longitudinal study was to identify physiologic effects of reinnervation on changes in heart rate at rest and in response to various stimulations and on atrial function after the Cox maze III procedure. Patients and methods: Power spectral analysis of heart rate variability, exercise testing, 24-hour Holter monitoring, electrocardiography, and transthoracic and transesophageal echocardiography were performed in 30 adult patients after the combined Cox maze III procedure and mitral valve surgery (maze group). They were prospectively followed up at 1, 3, 6, and 12 months after the operation. The results were compared with those of 15 heart transplant recipients (transplant group) and normal probands (healthy adults, n = 12). Results: The physiologic effects of denervation with no differences in cardiac autonomic activity between the groups were seen early after the operation. Later, evidence of autonomic reinnervation was observed only in the maze group but not in the transplant group. Inappropriate heart rate responses during physical exercise were clearly evident in both groups after 1 and 3 months, with progressive improvement seen between 6 and 12 months only in the maze group. Left atrial function after the Cox maze procedure improved parallel to the recovery of sinus node function. Conclusion: Progressive improvement of sinus node function and atrial contractions with significant functional normalization 1 year after the Cox maze procedure corresponded to functional reinnervation and recovery of the autonomic nervous system.

Original languageEnglish (US)
Pages (from-to)287-296
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume118
Issue number2
DOIs
StatePublished - 1999
Externally publishedYes

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Atrial Function
Sick Sinus Syndrome
Autonomic Nervous System
Ambulatory Electrocardiography
Sinoatrial Node
Heart Rate
Denervation
Left Atrial Function
Exercise
Transplants
Pulmonary Veins
Autologous Transplantation
Transesophageal Echocardiography
Mitral Valve
Longitudinal Studies
Echocardiography
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The Cox maze III procedure : Parallel normalization of sinus node dysfunction, improvement of atrial function, and recovery of the cardiac autonomic nervous system. / Pasic, M.; Musci, M.; Siniawski, H.; Grauhan, O.; Edelmann, B.; Tedoriya, T.; Weng, Y.; Hetzer, R.; Cox, J. L.; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 118, No. 2, 1999, p. 287-296.

Research output: Contribution to journalArticle

Pasic, M. ; Musci, M. ; Siniawski, H. ; Grauhan, O. ; Edelmann, B. ; Tedoriya, T. ; Weng, Y. ; Hetzer, R. ; Cox, J. L. ; Schaff, Hartzell V. / The Cox maze III procedure : Parallel normalization of sinus node dysfunction, improvement of atrial function, and recovery of the cardiac autonomic nervous system. In: Journal of Thoracic and Cardiovascular Surgery. 1999 ; Vol. 118, No. 2. pp. 287-296.
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AU - Pasic, M.

AU - Musci, M.

AU - Siniawski, H.

AU - Grauhan, O.

AU - Edelmann, B.

AU - Tedoriya, T.

AU - Weng, Y.

AU - Hetzer, R.

AU - Cox, J. L.

AU - Schaff, Hartzell V

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AB - Objective: The Cox maze HI procedure includes isolation of the pulmonary veins and multiple incisions in both atria in what corresponds to partial autotransplantation and partial denervation of the heart. The aim of this prospective longitudinal study was to identify physiologic effects of reinnervation on changes in heart rate at rest and in response to various stimulations and on atrial function after the Cox maze III procedure. Patients and methods: Power spectral analysis of heart rate variability, exercise testing, 24-hour Holter monitoring, electrocardiography, and transthoracic and transesophageal echocardiography were performed in 30 adult patients after the combined Cox maze III procedure and mitral valve surgery (maze group). They were prospectively followed up at 1, 3, 6, and 12 months after the operation. The results were compared with those of 15 heart transplant recipients (transplant group) and normal probands (healthy adults, n = 12). Results: The physiologic effects of denervation with no differences in cardiac autonomic activity between the groups were seen early after the operation. Later, evidence of autonomic reinnervation was observed only in the maze group but not in the transplant group. Inappropriate heart rate responses during physical exercise were clearly evident in both groups after 1 and 3 months, with progressive improvement seen between 6 and 12 months only in the maze group. Left atrial function after the Cox maze procedure improved parallel to the recovery of sinus node function. Conclusion: Progressive improvement of sinus node function and atrial contractions with significant functional normalization 1 year after the Cox maze procedure corresponded to functional reinnervation and recovery of the autonomic nervous system.

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