Getting Her Life Back

Teacher Undergoes Valve, Cox-Maze Surgery

Keeping up with work and family had become difficult for Susan Meyer, a first-grade teacher who was looking forward to her son’s upcoming wedding.

Meyer, 55, had lived with mitral valve stenosis for 15 years and was accustomed to not feeling 100 percent. But, as the wedding date approached, her symptoms worsened. “I was tired all the time,” she says. “My heartbeat had always been very irregular, but it was wearing me out more than usual.”

Meyer finally sought treatment in the emergency room when her symptoms became even more severe. Diagnotic tests determined she had atrial fibrillation (AF) — the most common type of irregular heart rhythm — and she was referred to Ralph Damiano Jr., MD, chief of Cardiothoracic Surgery at Washington University School of Medicine and Barnes-Jewish Hospital (BJH).
Damiano performed a successful surgery, giving Susan a new mechanical mitral valve, repairing another valve and performing a Cox-Maze procedure to correct the AF. All the procedures were done at once through a minimally invasive incision under the breast and, thus, Meyer avoided the dramatic scarring and longer recovery of a cracked-sternum procedure.
Meyer also benefited from the long-term experience of Washington University cardiac surgeons in treating AF. James Cox, MD, pioneered the Cox-Maze procedure — considered the gold standard of surgical AF treatment — at BJH in 1987.  Since then, BJH has seen patients from around the globe with AF, and its published success rates are the best worldwide.
The Cox-Maze procedure, when it was first developed, was a series of incisions that were placed around the left and right atrium to prevent the fibrillation from being able to sustain itself, explains Damiano. The operation is designed to block the conduction pathways needed to maintain AF.

In recent years, Damiano and his colleagues have modified the technically challenging “cut and sew” procedure using radiofrequency energy to heat heart tissue. Instead of making incisions, the surgical team creates lines of ablation, or scar tissue, on the heart muscle. The ablation lines redirect the abnormal electrical currents responsible for AF.
The new technique makes the procedure easier to perform, reduces OR time and improves patients’ recovery. “Our success rates in almost 200 patients are equal to those of the ‘cut and sew’ procedure,” says Damiano.
Since undergoing the modified Cox-Maze procedure and heart valve surgery, Meyer once again has energy for family and work. “I feel I have my life back,” she says.