Stulak John M, Dearani Joseph A, Daly Richard C, Zehr Kenton J, Sundt Thoralf M, Schaff Hartzell V
Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2006 Aug;82(2):494-500; discussion 500-1. doi: 10.1016/j.athoracsur.2006.03.075.
Atrial flutter or fibrillation with rapid, uncontrolled ventricular response may lead to left ventricular dysfunction, and conversion to sinus rhythm with control of heart rate can improve left ventricular ejection fraction. Little is known about the effects of the Cox-maze procedure on this form of tachycardia-induced cardiomyopathy.
Four hundred forty-three patients underwent the Cox-maze procedure from 1993 to 2002. Ninety-nine had atrial flutter or fibrillation without associated valvular or congenital heart disease, and 37 (37%) had decreased left ventricular function (ejection fraction < 0.35 in 11 [severe], ejection fraction 0.36 to 0.45 in 8 [moderate], and ejection fraction 0.46 to 0.55 in 18 [mild]). Ages of these 37 patients (34 male) ranged from 35 to 74 years (median, 55 years).
Atrial flutter or fibrillation was present for 3 months to 19 years (median, 48 months) preoperatively, and 24 patients (65%) exhibited symptoms of heart failure. Preoperative ejection fraction ranged from 0.25 to 0.55 (median, 0.45). At last follow-up (median, 63 months), the Cox-maze procedure eliminated atrial flutter or fibrillation in all but 1 patient, and the greatest improvement was observed in patients with severe preoperative impairment (0.31 to 0.53; p = 0.01, preoperative versus follow-up), and patients with preoperative chronic atrial flutter or fibrillation (0.43 to 0.55; p < 0.05 preoperative versus follow-up). This improvement was observed immediately postoperatively and was sustained at last follow-up. Further, improvement in left ventricular function correlated with enhancement of functional status.
In some patients, atrial flutter or fibrillation may be the cause rather than the consequence of left ventricular dysfunction. Importantly, systolic function and functional status can be significantly improved with the restoration of sinus rhythm by the Cox-maze procedure.
伴有快速、无法控制的心室反应的心房扑动或颤动可能导致左心室功能障碍，而恢复窦性心律并控制心率可改善左心室射血分数。关于Cox迷宫手术对这种形式的心动过速性心肌病的影响，人们了解甚少。
1993年至2002年期间，443例患者接受了Cox迷宫手术。99例患有心房扑动或颤动，无相关瓣膜或先天性心脏病，其中37例（37%）左心室功能下降（11例射血分数<0.35[重度]，8例射血分数0.36至0.45[中度]，18例射血分数0.46至0.55[轻度]）。这37例患者（34例男性）年龄在35至74岁之间（中位数为55岁）。
术前心房扑动或颤动持续3个月至19年（中位数为48个月），24例患者（65%）出现心力衰竭症状。术前射血分数范围为0.25至0.55（中位数为0.45）。在最后一次随访时（中位数为63个月），除1例患者外，Cox迷宫手术消除了所有患者的心房扑动或颤动，术前严重受损患者改善最为明显（从0.31至0.53；术前与随访相比，p = 0.01），术前患有慢性心房扑动或颤动的患者也有改善（从0.43至0.55；术前与随访相比，p < 0.05）。这种改善在术后立即观察到，并在最后一次随访时持续存在。此外，左心室功能的改善与功能状态的增强相关。
在一些患者中，心房扑动或颤动可能是左心室功能障碍的原因而非结果。重要的是，通过Cox迷宫手术恢复窦性心律可显著改善收缩功能和功能状态。
