Prasad Sunil M, Maniar Hersh S, Camillo Cindy J, Schuessler Richard B, Boineau John P, Sundt Thoralf M, Cox James L, Damiano Ralph J
Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO 63110, USA.
J Thorac Cardiovasc Surg. 2003 Dec;126(6):1822-8. doi: 10.1016/s0022-5223(03)01287-x.
For the last decade, the Cox maze III procedure has been available for the treatment of atrial fibrillation. It is unknown whether the operation has similar efficacy in patients with lone atrial fibrillation compared with that in patients with atrial fibrillation associated with coronary, valve, or congenital heart disease. This study examined the long-term outcome of patients who underwent this procedure either as a lone operation or as a concomitant procedure.
From 1988 to 2001, 198 patients underwent a Cox maze III procedure; 112 were lone operations, and 86 were concomitant procedures. Major complications included renal failure, reoperation for bleeding, mediastinitis, stroke, and balloon pump insertion. Follow-up was performed by means of mail and telephone questionnaires with both the patients and their cardiologists. All patients who had any history of arrhythmia or who were taking medication had their rhythm documented by means of electrocardiography.
The lone operation group was significantly younger (51.3 +/- 10.5 vs 58.8 +/- 9.9 years) and had a higher male/female ratio (4:1 vs 2:1). There was no difference in operative mortality between groups (1.8% vs 1.2%). At a follow-up of 5.4 +/- 2.9 years, 96.6% (172/178) of all patients were free of atrial fibrillation. There was no difference between the lone operation and concomitant procedure groups (95.9% vs 97.5%).
The Cox maze III procedure has equivalent operative risk and long-term efficacy in patients undergoing both lone operations and concomitant procedures. The Cox maze III procedure remains the standard against which alternative procedures for atrial fibrillation must be judged.
在过去十年中，Cox迷宫III手术已可用于治疗心房颤动。与合并冠心病、瓣膜病或先天性心脏病的心房颤动患者相比，该手术在孤立性心房颤动患者中是否具有相似疗效尚不清楚。本研究调查了接受该手术作为单独手术或同期手术患者的长期预后。
1988年至2001年，198例患者接受了Cox迷宫III手术；112例为单独手术，86例为同期手术。主要并发症包括肾衰竭、因出血再次手术、纵隔炎、中风和置入球囊泵。通过邮件和电话问卷对患者及其心脏病专家进行随访。所有有任何心律失常病史或正在服药的患者均通过心电图记录其心律。
单独手术组患者明显更年轻（51.3±10.5岁对58.8±9.9岁），男女比例更高（4:1对2:1）。两组手术死亡率无差异（1.8%对1.2%）。在5.4±2.9年的随访中，所有患者中有96.6%（172/178）无房颤。单独手术组和同期手术组之间无差异（95.9%对97.5%）。
Cox迷宫III手术在接受单独手术和同期手术的患者中具有相当的手术风险和长期疗效。Cox迷宫III手术仍是评判心房颤动替代手术的标准。
