Cox-Maze procedure patient case study
Complex and higher-risk reoperative surgery has become commonplace as patients live longer. This case study involves a patient with chronic A-fib and an opportunity to restore A-V synchrony in the setting of severe LV dysfunction (EF=20%), ostial left main stenosis and ischemic mitral regurgitation.
Hongkie Yun, a 72-year-old retired anesthesiologist, presented with a history of prior single-vessel bypass surgery to the LAD 25 years ago. He required multiple interventions secondary to early occlusion of the LIMA graft. He now presents with longstanding A-fib and exertional angina in the setting of decompensated left-ventricular function with reduction of EF to 20%. Left-ventricular dimension at end diastole was 5.2cm. At least moderate mitral regurgitation was present. Cardiac catheterization, performed at an outside institution, confirmed occlusion of the LIMA graft, while revealing ostial left main stenosis and high-grade proximal LAD disease. He was referred by his cardiologist to Dr. Castro at Sequoia Hospital.
Complex Cox-Maze procedure
A redo-sternotomy was performed without complication. Oncardiopulmonary bypass, a full cut-and-sew Cox-Maze procedure was performed, which always includes excision of the left-atrial appendage. In addition, mitral valve repair and complex two-vessel bypass to a deeply intramyocardial LAD, as well as an A-V groove left circumflex was performed. An intra-aortic balloon pump was used to maximize afterload reduction and LV recovery.
When results matter
Nearly a year since Dr. Yun’s operation, he has remained in sinus rhythm and has been taken off coumadin. Most recent echocardiography revealed full recovery of the left ventricle, normalized ejection fraction (60%), and no mitral regurgitation.
Dr. Yun has returned to his busy life back home. He is golfing, gardening, and enjoying life. “Prior to surgery, my Dad felt tired all the time. Now he feels stronger, younger, and he says his vision is even brighter,” explains his son Paul, a private-practice otolaryngologist.
Paul has watched his father blossom after his second heart surgery. He says, “My dad feels younger now after surgery and is able to keep up with his eight grandchildren.”