Pasic M, Musci M, Siniawski H, Grauhan O, Edelmann B, Tedoriya T, Weng Y, Hetzer R
Deutsches Herzzentrum Berlin, Linik für Herz-, Thorax- und Gefässchirurgie, Augustenburger Platz 1, D-13353 Berlin, Germany.
J Thorac Cardiovasc Surg. 1999 Aug;118(2):287-95. doi: 10.1016/S0022-5223(99)70219-9.
The Cox maze III 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.
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).
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.
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.
Cox迷宫III手术包括肺静脉隔离以及在两个心房进行多处切口，这相当于心脏的部分自体移植和部分去神经支配。这项前瞻性纵向研究的目的是确定再神经支配对Cox迷宫III手术后静息心率及对各种刺激的反应变化以及心房功能的生理影响。
对30例成年患者在接受Cox迷宫III手术和二尖瓣手术联合治疗后（迷宫组）进行心率变异性的功率谱分析、运动试验、24小时动态心电图监测、心电图检查以及经胸和经食管超声心动图检查。在术后1、3、6和12个月对他们进行前瞻性随访。将结果与15例心脏移植受者（移植组）和正常对照者（健康成年人，n = 12）的结果进行比较。
术后早期可见去神经支配的生理效应，各组间心脏自主神经活动无差异。后来，仅在迷宫组观察到自主神经再支配的证据，而移植组未观察到。术后1个月和3个月时，两组在体育锻炼期间均明显出现不适当的心率反应，仅迷宫组在6至12个月间有逐渐改善。Cox迷宫手术后左心房功能的改善与窦房结功能的恢复平行。
Cox迷宫手术后1年，窦房结功能和心房收缩逐渐改善，功能显著正常化，这与自主神经系统的功能再支配和恢复相对应。
