A new procedure for chronic atrial fibrillation: Bilateral appendage-preserving maze procedure

Background. Atrial transport and atrial natriuretic peptide secretion is se verely reduced from normal after the maze III procedure. To improve these f actors, we developed a bilateral appendage-preserving maze procedure (BAP-m aze). Methods. Forty-six patients with chronic atrial fibrillation who underwent the BAP-maze procedure were compared with 40 patients who underwent the maz e III procedure. The ratio of the peak velocity of the A and E waves of tra nsmitral flow (transthoracic pulsed Doppler echocardiography), the left atr ial appendage ejection fraction (transesophageal echocardiography), and the atrial natriuretic peptide secretory reserve during treadmill exercise tes t were measured at 6 months postoperatively. Results. Sinus rhythm was restored in 44 patients (95.7%) by the BAP-maze p rocedure and in 39 patients (97.5%) by the maze III procedure. The ratio of the peak velocity of the A and E waves was 0.52 +/- 0.22 in the BAP-maze g roup and 0.25 +/- 0.19 in the maze III group (p < 0.0001). The left atrial appendage ejection fraction was 44.7% +/- 11.5%, and the atrial natriuretic peptide secretory reserve was greater in the BAP maze group (p = 0.037). C onclusions. The BAP-maze procedure improved atrial transport and atrial nat riuretic peptide secretion as well as simplifying the maze operation, witho ut decreasing its effectiveness against atrial fibrillation. (C) 2001 by Th e Society of Thoracic Surgeons.