Gillinov Marc
The Center for Atrial Fibrillation Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
J Interv Card Electrophysiol. 2007 Dec;20(3):101-7. doi: 10.1007/s10840-007-9171-4.
Atrial fibrillation (AF) is present in 30-50% of patients presenting for mitral valve surgery. If left untreated, AF in these patients is associated with increased morbidity and, possibly, increased mortality. Therefore, concomitant management of the arrhythmia is indicated in most mitral valve patients with preexisting AF. The cut-and-sew Cox-Maze III procedure is extremely effective, eliminating AF in 80-95%; however, it has been supplanted by newer operations that rely upon alternate energy sources to create lines of conduction block. Early and midterm results are good with a variety of technologies. Choice of lesion set remains a matter of debate, but success of ablation appears to be enhanced by a biatrial lesion set and exceeds 90% in some series. Targeted areas for improvement in combined mitral valve surgery and AF ablation include acceptance of uniform standards for reporting results, development of improved technology for ablation and intraoperative assessment, and creation of instrumentation that facilitates minimally invasive approaches.
在接受二尖瓣手术的患者中，30%-50%存在心房颤动（AF）。如果不进行治疗，这些患者的房颤会增加发病率，甚至可能增加死亡率。因此，大多数合并房颤的二尖瓣患者都需要同时处理心律失常。切割缝合式Cox迷宫III手术极为有效，可使80%-95%的患者消除房颤；然而，它已被依赖其他能量来源来形成传导阻滞线的新型手术所取代。各种技术的早期和中期效果都很好。病变组的选择仍存在争议，但双心房病变组似乎能提高消融成功率，在一些系列研究中超过90%。二尖瓣手术与房颤消融联合治疗有待改进的目标领域包括接受统一的结果报告标准、开发改进的消融技术和术中评估方法，以及制造便于微创方法的器械。
