Cox迷宫手术治疗心房颤动的十年经验：我们如何定义成功？

Ten-year experience with the Cox-maze procedure for atrial fibrillation: how do we define success?

作者信息

Stulak John M, Sundt Thoralf M, Dearani Joseph A, Daly Richard C, Orsulak Thomas A, Schaff Hartzell V

机构信息

Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.

出版信息

Ann Thorac Surg. 2007 Apr;83(4):1319-24. doi: 10.1016/j.athoracsur.2006.11.007.

DOI:10.1016/j.athoracsur.2006.11.007

PMID:17383333

Abstract

BACKGROUND

The Cox-maze procedure is the standard to which other surgical treatments of atrial fibrillation (AF) are compared. However, evaluation of new devices and lesion sets is difficult because of variable methods of reporting success in eliminating AF. We analyzed 10-year outcome with the "cut and sew" Cox-maze procedure and present rhythm at last follow-up, interval contact, and actuarial AF freedom.

METHODS

Between March 1993 and December 2002, 335 patients (211 men) underwent the Cox-maze procedure (age, 22 to 83 years; median, 62 years). Atrial fibrillation was chronic (CAF) in 175 patients and paroxysmal (PAF) in 160.

RESULTS

Concomitant mitral valve procedures were performed in 59%, coronary artery bypass grafting in 19%, and tricuspid valve repairs in 7%. Early mortality was 0.9%. During hospitalization, transient AF occurred in 29% of patients and 10% required implantation of a new permanent pacemaker (PPM). Dismissal electrocardiogram was normal sinus rhythm in 64%, junctional rhythm in 18%, AF in 11%, and PPM in 7%. At last follow-up (mean 42 +/- 6 months), 88% of patients were free of AF. However, when analyzed by the Kaplan-Meier method, freedom from AF was lower for patients with preoperative lone PAF (5 years, 90%; 10 years, 64%), preoperative lone CAF (5 years, 80%; 10 years, 62%), and patients undergoing combined maze-mitral valve surgery (5 years, 68%; 10 years, 41%).

CONCLUSIONS

Ten-year results with the standard Cox-maze procedure confirm high effectiveness, but reporting methods should be standardized to account for patients who have transient atrial arrhythmias during long-term follow-up.

摘要

背景

Cox迷宫手术是用于比较其他心房颤动（AF）外科治疗方法的标准。然而，由于消除AF成功的报告方法各异，对新设备和损伤集的评估存在困难。我们分析了采用“切割缝合”Cox迷宫手术的10年结果，并呈现了最后一次随访时的心律、间期接触情况以及AF无发生概率。

方法

1993年3月至2002年12月期间，335例患者（211例男性）接受了Cox迷宫手术（年龄22至83岁；中位数62岁）。其中175例患者为慢性心房颤动（CAF），160例为阵发性心房颤动（PAF）。

结果

59%的患者同时进行了二尖瓣手术，19%进行了冠状动脉搭桥术，7%进行了三尖瓣修复术。早期死亡率为0.9%。住院期间，29%的患者出现短暂性AF，10%的患者需要植入新的永久性起搏器（PPM）。出院时心电图显示正常窦性心律的患者占64%，交界性心律的患者占18%，AF的患者占11%，PPM的患者占7%。在最后一次随访时（平均42±6个月），88%的患者无AF。然而，采用Kaplan-Meier方法分析时，术前孤立性PAF患者（5年时为90%；10年时为64%）、术前孤立性CAF患者（5年时为80%；10年时为62%）以及接受迷宫-二尖瓣联合手术的患者（5年时为68%；10年时为41%）的AF无发生概率较低。