Gillinov A Marc, Sirak Jon, Blackstone Eugene H, McCarthy Patrick M, Rajeswaran Jeevanantham, Pettersson Gosta, Sabik F Joseph, Svensson Lars G, Navia Jose L, Cosgrove Delos M, Marrouche Nassir, Natale Andrea
Center for Atrial Fibrillation and the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Thorac Cardiovasc Surg. 2005 Dec;130(6):1653-60. doi: 10.1016/j.jtcvs.2005.07.028. Epub 2005 Oct 26.
The Cox maze procedure is the gold standard for ablation of atrial fibrillation in patients undergoing mitral valve surgery, and new approaches to atrial fibrillation ablation must be compared with it. Therefore, we sought to determine the time-related prevalence of atrial fibrillation and its risk factors after combined Cox maze and mitral valve surgery.
From November 1991 through January 2004, 263 patients (mean left atrial diameter, 5.8 +/- 1.2 cm) underwent combined mitral valve surgery (repair in 71%) and a cut-and-sew Cox maze procedure for atrial fibrillation (permanent, 74%; persistent, 7%; paroxysmal, 16%). Rhythm documented on 2367 postoperative electrocardiograms was used to estimate the prevalence of atrial fibrillation across time.
Hospital mortality was 1.9%. Postoperative atrial fibrillation prevalence peaked at 36% at 2 weeks, decreasing to 21% at 5 years. Risk factors for higher postoperative atrial fibrillation prevalence varied with time and included longer duration of preoperative atrial fibrillation (P = .003), larger left atrial diameter (P = .01), older age (P = .0002), and higher left ventricular mass index (P = .02).
In some patients undergoing mitral valve surgery and a Cox maze procedure, atrial fibrillation recurs over time, mandating close, long-term follow-up of heart rhythm. Earlier operation and left atrial size reduction should be considered to improve results in selected patients.
考克斯迷宫手术是二尖瓣手术患者房颤消融的金标准，新的房颤消融方法必须与之进行比较。因此，我们试图确定考克斯迷宫手术联合二尖瓣手术后房颤的时间相关患病率及其危险因素。
从1991年11月至2004年1月，263例患者（平均左房直径5.8±1.2cm）接受了二尖瓣联合手术（71%为修复手术）及用于房颤治疗的切割缝合式考克斯迷宫手术（永久性房颤占74%；持续性房颤占7%；阵发性房颤占16%）。利用术后2367份心电图记录的心律来估计不同时间点房颤的患病率。
住院死亡率为1.9%。术后房颤患病率在2周时达到峰值36%，5年时降至21%。术后房颤患病率较高的危险因素随时间变化，包括术前房颤持续时间较长（P = 0.003）、左房直径较大（P = 0.01）、年龄较大（P = 0.0002）和左室质量指数较高（P = 0.02）。
在一些接受二尖瓣手术和考克斯迷宫手术的患者中，房颤会随时间复发，因此需要对心律进行密切的长期随访。对于特定患者，应考虑尽早手术和减小左房大小以改善治疗效果。
