Aidietis Audrius, Rucinskas Kestutis, Sirvydis Vytautas, Jurkuvenas Paulius, Grebelis Arimantas, Marinskis Germanas, Uzdavinys Giedrius
Clinic of Heart Diseases, Vilnius University, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:1-6.
The Cox-maze procedure is an effective established surgical method for elimination of atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation as a surgical adjunct in treating atrial fibrillation and to adapt maze principles to mitral valve surgery using transseptal approaches.
Thirty-six patients underwent radiofrequency modified maze procedure using standard and cooled ablation electrodes in combination with surgery for hemodynamically significant mitral valve disease and chronic, persistent or paroxysmal atrial fibrillation. Fourteen (39%) patients had mitral valve repair and 22 (61%) patients had mitral valve replacement; 33 (91.6%) patients underwent concomitant surgical procedures.
The cardiopulmonary bypass time was 162+/-38 min, the aortic cross-clamp time - 98+/-22 min. The additional aortic cross-clamp time required for the radiofrequency modified maze procedure was 21+/-3 min. Postoperative mortality was 2.8%. In 7 of 36 pts (19.4% ) significant bradycardia requiring permanent pacing (six - AAI, one - DDD) was seen after the operation. Patients were followed up for 4 months to 2.5 years after surgery (mean 11.2+/-7.4 months). There were no deaths, no thromboembolic complications during follow-up. Freedom from atrial fibrillation or flutter was 100% at the end of operation, but during 0.5-3 months after operation atrial fibrillation or flutter were observed in 41.6% (15/36) patients. In 2 (5%) patients chronic atrial fibrillation developed. Freedom from atrial fibrillation/flutter was 86% (12/14) at 1 year postoperatively.
The radiofrequency modified maze as an adjunctive procedure is safe and effective in eliminating atrial fibrillation using standard and cooling-tip ablation electrodes in combination with surgery for mitral valve disease.
Cox迷宫手术是一种已确立的消除心房颤动的有效外科手术方法。本研究的目的是评估射频消融作为治疗心房颤动的手术辅助手段的有效性和安全性，并将迷宫原理应用于经房间隔途径的二尖瓣手术。
36例患者接受了射频改良迷宫手术，使用标准和冷却消融电极，同时进行手术治疗具有血流动力学意义的二尖瓣疾病以及慢性、持续性或阵发性心房颤动。14例（39%）患者进行了二尖瓣修复，22例（61%）患者进行了二尖瓣置换；33例（91.6%）患者接受了同期手术。
体外循环时间为162±38分钟，主动脉阻断时间为98±22分钟。射频改良迷宫手术所需的额外主动脉阻断时间为21±3分钟。术后死亡率为2.8%。36例患者中有7例（19.4%）术后出现需要永久起搏的显著心动过缓（6例为AAI，1例为DDD）。患者术后随访4个月至2.5年（平均11.2±7.4个月）。随访期间无死亡病例，无血栓栓塞并发症。术后即刻心房颤动或扑动的消除率为100%，但术后0.5 - 3个月内，41.6%（15/36）的患者出现了心房颤动或扑动。2例（5%）患者发展为慢性心房颤动。术后1年时，心房颤动/扑动的消除率为86%（12/14）。
射频改良迷宫手术作为一种辅助手术，在使用标准和冷却尖端消融电极结合二尖瓣疾病手术时，对于消除心房颤动是安全有效的。
