Topkara Veli K, Williams Mathew R, Cheema Faisal H, Vigilance Deon W, Garrido Mauricio J, Russo Mark J, Oz Mehmet C, Argenziano Michael
Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Division of Cardiothoracic Surgery, New York, NY 10032, USA.
J Card Surg. 2006 Sep-Oct;21(5):441-8. doi: 10.1111/j.1540-8191.2006.00273.x.
The Maze III procedure is an effective surgical treatment for atrial fibrillation (AF). However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach.
This study involves patients undergoing surgical atrial fibrillation ablation (SAFA) at a single institution from 1999 to 2005. Type of concomitant procedures, preoperative clinical characteristics, and chronicity of AF were evaluated in overall patient population. Parameters including surgical approach, lesion pattern, and energy source used were collected intraoperatively. Clinical outcomes examined were postoperative rhythm success, stroke, early mortality, and long-term survival.
Three hundred thirty-nine patients were identified. Three hundred twenty-eight (96.8%) patients had associated cardiac disease and underwent concomitant procedures; 75.8% of patients had persistent AF. Energy sources used were microwave (49.8%), radiofrequency (42.2%), and laser (8.0%). In 41.9% of cases a pulmonary vein encircling lesion was the only lesion created. Combination lesion sets were performed in the remaining cases. Rhythm success rates at 3, 6, 12, and 24 months were 74.1%, 68.2%, 74.5%, and 71.1%, respectively. Patients who underwent surgical removal of left atrial appendage by means of stapling or simple excision had no early postoperative stroke. Early mortality was 4.9%. Postoperative survival rates at 1, 3, and 5 years were 89.6%, 83.1%, and 78.0%.
Surgical ablation of atrial fibrillation is a safe and effective procedure in restoring sinus rhythm with excellent postoperative survival rates. Further advancements in the field will eventually result in minimally invasive procedures with higher success rates.
迷宫III手术是治疗心房颤动（AF）的一种有效外科治疗方法。然而，由于其复杂性、手术时间延长以及出血风险，该方法并未得到广泛应用。已引入各种能量源以简化传统的“切割与缝合”方法。
本研究纳入了1999年至2005年在单一机构接受外科房颤消融（SAFA）的患者。在总体患者人群中评估了同期手术类型、术前临床特征以及房颤的慢性程度。术中收集包括手术方式、病变模式和所使用能量源等参数。所检查的临床结局包括术后节律成功、中风、早期死亡率和长期生存率。
共确定了339例患者。328例（96.8%）患者患有相关心脏病并接受了同期手术；75.8%的患者患有持续性房颤。所使用的能量源为微波（49.8%）、射频（42.2%）和激光（8.0%）。在41.9%的病例中，肺静脉环绕病变是唯一创建的病变。其余病例采用联合病变组。3个月、6个月、12个月和24个月时的节律成功率分别为74.1%；68.2%；74.5%和71.1%。通过吻合器或简单切除进行左心耳手术切除的患者术后早期未发生中风。早期死亡率为4.9%。1年、3年和5年的术后生存率分别为89.6%、83.1%和78.0%。
房颤的外科消融是恢复窦性心律的一种安全有效的方法，术后生存率良好。该领域的进一步进展最终将导致成功率更高的微创手术。
