de Lima Gustavo Glotz, Kalil Renato A K, Leiria Tiago L L, Hatem Domingos M, Kruse Claudio L, Abrahão Rogério, Sant'anna João R M, Prates Paulo R, Nesralla Ivo A
Department of Electrophysiology, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
Ann Thorac Surg. 2004 Jun;77(6):2089-94; discussion 2094-5. doi: 10.1016/j.athoracsur.2003.11.018.
The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with atrial fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery.
A prospective clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1). associated en bloc isolation of pulmonary veins, (2). the Maze procedure, or (3). mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups.
The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins (p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group (p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group.
En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation.
考克斯迷宫手术已用于治疗二尖瓣疾病患者的心房颤动。最近，在心房颤动患者中发现了起源于肺静脉的异位灶，这表明他们的心律失常可能有局灶性起源。鉴于这一新证据，开发了一种简化的手术技术来隔离肺静脉，以消除接受二尖瓣手术患者的永久性心房颤动。本研究比较了三种旨在维持二尖瓣手术后窦性心律的手术方法。
一项针对30例患有二尖瓣疾病和永久性心房颤动且已接受二尖瓣手术的患者的前瞻性临床试验，根据每位患者所采用的手术类型进行随机分组：（1）. 联合整块隔离肺静脉；（2）. 迷宫手术；或（3）. 单纯二尖瓣矫正术。三组患者术前的临床特征相似。
三组患者术后总体并发症相似。对照组的体外循环时间和主动脉阻断时间较短，但这一因素与干预组发病率的增加无关。与对照组相比，肺静脉隔离组术后心房颤动的相对风险为0.08（p = 0.010；95%置信区间，0.01至0.71），迷宫手术组为0.20（p = 0.044；95%置信区间，0.04至1.02）。
二尖瓣手术联合整块隔离肺静脉在维持永久性心房颤动患者的窦性心律方面似乎是安全的，且与迷宫手术同样有效。
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