Romano Matthew A, Bach David S, Pagani Francis D, Prager Richard L, Deeb G Michael, Bolling Steven F
Section of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Ann Thorac Surg. 2004 Apr;77(4):1282-7; discussion 1287. doi: 10.1016/j.athoracsur.2003.06.022.
The Cox maze procedure yields good results for atrial fibrillation (AF). However, patients with predictors of failure-chronic long-standing AF, low amplitude fibrillatory waves, and large left atriums-are generally thought not to benefit from a maze procedure. We report an aggressive approach for these patients, utilizing biatrial reduction plasty concomitantly with the Cox maze procedure for AF.
A complete Cox maze procedure utilizing supplemental RF ablation was performed in 36 patients. All underwent resection of both atrial appendages and biatrial reduction plasty encompassing resection of the left atrial posterior wall from left to right pulmonary veins and from inferior pulmonary veins to the mitral annulus, as well as removal of the right atrial lateral wall. Mitral or tricuspid valve repair, or both, was performed on 32 patients.
These patients had a mean AF duration of 45 +/- 89 months. Their preoperative left atria measured 66 +/- 16 mm, with mean AF waves of 0.74 +/- 0.3 mm. Mean preoperative New York Heart Association class was 2.7 +/- 0.7 and left ventricular ejection fraction was 48 +/- 9. Cross clamp and bypass times were 91 +/- 35 minutes and 124 +/- 33 minutes, respectively. The average posterior left atrial tissue resected was 5.4 x 2.1 cm, and mean resected atrial weight was 10.3 +/- 2 g. There were no deaths and length of stay was 5.5 +/- 2 days. At a follow-up time of 19 +/- 16 months, 32 of the 36 patients were in normal sinus rhythm and New York Heart Association class I.
Aggressive biatrial reduction plasty Cox maze procedure was effective in 89% of these "low success" AF patients. This simple procedure can extend utilization of the Cox maze procedure to more patients with chronic AF.
Cox迷宫手术治疗心房颤动（AF）效果良好。然而，具有失败预测因素——慢性长期房颤、低振幅颤动波和左心房增大——的患者通常被认为无法从迷宫手术中获益。我们报告一种针对这些患者的积极治疗方法，即同时进行双心房减容整形术和Cox迷宫手术治疗房颤。
对36例患者进行了采用补充射频消融的完整Cox迷宫手术。所有患者均切除双侧心耳并进行双心房减容整形术，包括从左肺静脉至右肺静脉以及从下肺静脉至二尖瓣环切除左心房后壁，以及切除右心房侧壁。32例患者进行了二尖瓣或三尖瓣修复，或两者均进行了修复。
这些患者房颤平均持续时间为45±89个月。术前左心房直径为66±16mm，平均房颤波为0.74±0.3mm。术前纽约心脏协会心功能分级平均为2.7±0.7，左心室射血分数为48±9。主动脉阻断时间和体外循环时间分别为91±35分钟和124±33分钟。平均切除的左心房后壁组织为5.4×2.1cm，平均切除心房重量为10.3±2g。无死亡病例，住院时间为5.5±2天。在19±16个月的随访时，36例患者中有32例处于正常窦性心律且纽约心脏协会心功能分级为I级。
积极的双心房减容整形Cox迷宫手术对89%的这些“低成功率”房颤患者有效。这种简单的手术可将Cox迷宫手术的适用范围扩大到更多慢性房颤患者。
