Damiano Ralph J, Voeller Rochus K
Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Curr Treat Options Cardiovasc Med. 2006 Sep;8(5):371-6. doi: 10.1007/s11936-006-0041-7.
The Cox-Maze procedure, first introduced in 1987, has been the gold standard for the surgical treatment of atrial fibrillation. At 10 years, over 90% of patients remain free from atrial fibrillation. The procedure has been shown to be effective at eliminating the incidence of late stroke in this high-risk population. The development of new ablation technologies has greatly simplified and shortened the Cox-Maze procedure without sacrificing efficacy. These technologies have spurred interest in the development of new, simpler operations for the surgical treatment of atrial fibrillation that can be performed through minimal access and, in some instances, off of cardiopulmonary bypass. The early results with these more limited procedures on the whole have not been as good as with the Cox-Maze procedure, but they are promising. There are many problems with the development of a truly minimally invasive procedure with high efficacy. When patients are referred for surgery, there is no information available regarding the mechanisms of their atrial fibrillation. Thus, it is impossible to tailor the ablation to the individual patient. Future progress will require better understanding of the mechanisms of atrial fibrillation, and the development and refinement of clinical diagnostic technology that will allow for better preoperative diagnosis.
1987年首次引入的Cox迷宫手术一直是心房颤动外科治疗的金标准。10年后，超过90%的患者不再患有心房颤动。该手术已被证明在消除这一高危人群中晚期中风的发生率方面是有效的。新消融技术的发展极大地简化和缩短了Cox迷宫手术，同时不影响疗效。这些技术激发了人们对开发新的、更简单的心房颤动外科治疗手术的兴趣，这些手术可以通过微创方式进行，在某些情况下甚至可以在非体外循环下进行。总体而言，这些更有限的手术的早期结果不如Cox迷宫手术，但很有前景。开发一种真正高效的微创手术存在许多问题。当患者被转诊进行手术时，没有关于其心房颤动机制的可用信息。因此，不可能根据个体患者定制消融治疗。未来的进展将需要更好地理解心房颤动的机制，以及开发和完善临床诊断技术，以便能够进行更好的术前诊断。
