Ishii Y, Nitta T, Fujii M, Ogasawara H, Iwaki H, Ohkubo N, Tanaka S
Department of Cardiothoracic Surgery, Nippon Medical School, Tokyo, Japan.
Ann Thorac Surg. 2001 Feb;71(2):572-6. doi: 10.1016/s0003-4975(00)02520-0.
The left atrial transport function recovers slowly over several months after the maze procedure (Maze), but remains at a low level even during the long-term postoperative period. Because the Maze leaves an insufficient left atrial transport function, patients may still be prone to thromboembolism after the Maze. The radial incision approach (Radial) has been shown to preserve greater atrial transport function than does the Maze in the early postoperative period.
To examine the serial change in the atrial transport function after the Radial, out of 32 patients who underwent the Radial, 15 patients were assessed by transthoracic Doppler echocardiography 1, 3, 6, and 12 months after surgery. The atrial filling fraction and peak A/E velocity ratio were determined from the flow-velocity spectra across the mitral and tricuspid valves. The incidence of thromboembolic events was examined in 21 patients who were followed for more than 3 months after the Radial. The data were compared with data obtained from 13 patients after (41 +/- 6 months) the Maze III procedure.
The left atrial transport function after the Radial increased within 3 months to a significantly greater level than did that after the Maze in the longterm. The atrial filling fraction was 28.2% +/- 7.9% at 3 months after the Radial and 15.1% +/- 4.0% at 41 months after the Maze (p < 0.01). The peak A/E ratio was 0.52 +/- 0.18 at 3 months after the Radial and 0.25 +/- 0.07 at 41 months after the Maze (p < 0.01). This increased atrial transport function was maintained for an extended period after the Radial. There were no thromboembolic events in any of the patients after the Radial or Maze, irrespective of postoperative anticoagulant therapy.
The Radial approach prevents thromboembolism by restoring sufficient atrial transport function more effectively and faster than does the Maze.
迷宫手术（Maze）后，左心房运输功能在数月内缓慢恢复，但即使在术后长期仍维持在较低水平。由于迷宫手术导致左心房运输功能不足，患者在迷宫手术后仍可能易于发生血栓栓塞。在术后早期，放射状切口手术（Radial）已被证明比迷宫手术能保留更好的心房运输功能。
为了研究Radial手术后心房运输功能的系列变化，在32例行Radial手术的患者中，15例患者在术后1、3、6和12个月接受经胸多普勒超声心动图检查。从二尖瓣和三尖瓣处的流速频谱确定心房充盈分数和A/E峰值速度比。在21例Radial手术后随访超过3个月的患者中检查血栓栓塞事件的发生率。将这些数据与13例迷宫III手术（41±6个月后）后的患者的数据进行比较。
Radial手术后左心房运输功能在3个月内增加，且长期来看显著高于迷宫手术后的水平。Radial手术后3个月时心房充盈分数为28.2%±7.9%，迷宫手术后41个月时为15.1%±4.0%（p<0.01）。Radial手术后3个月时A/E峰值比为0.52±0.18，迷宫手术后41个月时为0.25±0.07（p<0.01）。Radial手术后这种增加的心房运输功能持续了较长时间。Radial手术或迷宫手术后的任何患者均未发生血栓栓塞事件，无论术后是否进行抗凝治疗。
与迷宫手术相比，Radial手术通过更有效、更快地恢复足够的心房运输功能来预防血栓栓塞。
