Ghavidel Alireza Alizadeh, Javadpour Hossein, Shafiee Massoud, Tabatabaie Mohammad-Bagher, Raiesi Kamal, Hosseini Saeed
Department of Cardiovascular Surgery, Rajaee Heart Centre, Vali e Asr Avenue, Tehran, Iran.
Eur J Cardiothorac Surg. 2008 Jun;33(6):1043-8. doi: 10.1016/j.ejcts.2008.03.019. Epub 2008 Apr 29.
Although the classical Cox-Maze III is the gold standard surgical therapy with a proven efficacy in the treatment of atrial fibrillation (AF), complexity of this procedure has resulted in a search for a simpler, less invasive and more cost-effective method. In this study we evaluated the results of cryosurgical ablation in the treatment of chronic AF in patients undergoing concomitant mitral valve surgery.
Ninety patients (mean age: 50.9+/-12 years) with chronic AF who were having mitral valve surgery as the main procedure underwent cryoablation with a newly designed N(2)O-based cryotherapy device. Pulmonary vein isolation with or without left atrial appendage closure (group A) was carried out in 65 cases and cryoablative bi-atrial Cox-Maze III (group B) in 25 patients. This additional procedure took only an extra 10 min for group A and about 20 min for group B. Half of the patients received a beta-blocker following the procedure.
The overall success rate of cryoablation was 65.5%. Normal sinus rhythm was achieved in 26.7% in the operating room, 10% in ICU and the remaining cases reverted to sinus rhythm during the follow-up period. There were no major ablation-related complications such as bleeding, thromboembolic events or A-V block. The only predictor for failure of ablative procedure was left atrial size of greater than 6 cm.
Although in this study the efficacy rate of cryoablative surgery was not the same as classical Cox-Maze III, it seems that this procedure is safe, simple, cost-effective and at the same time does not increase the operative time significantly. Using cryoablation may enhance the cure rate of chronic AF during mitral valve surgery.
尽管经典的Cox迷宫III手术是治疗心房颤动（AF）的金标准手术疗法，已证实其疗效，但该手术的复杂性促使人们寻求一种更简单、侵入性更小且更具成本效益的方法。在本研究中，我们评估了冷冻消融术在接受同期二尖瓣手术的慢性AF患者中的治疗效果。
90例以二尖瓣手术为主的慢性AF患者（平均年龄：50.9±12岁），使用新设计的基于N₂O的冷冻治疗设备进行冷冻消融。65例患者进行了肺静脉隔离，伴或不伴有左心耳闭合（A组），25例患者进行了冷冻双房Cox迷宫III手术（B组）。该附加手术A组仅额外耗时10分钟，B组约20分钟。一半患者术后接受了β受体阻滞剂治疗。
冷冻消融的总体成功率为65.5%。在手术室中，26.7%的患者恢复窦性心律，在重症监护病房（ICU）为10%，其余患者在随访期间恢复窦性心律。未发生与消融相关的重大并发症，如出血、血栓栓塞事件或房室传导阻滞。消融手术失败的唯一预测因素是左心房直径大于6 cm。
尽管在本研究中冷冻消融手术的有效率与经典的Cox迷宫III不同，但该手术似乎安全、简单、具有成本效益，且同时不会显著增加手术时间。使用冷冻消融术可能会提高二尖瓣手术期间慢性AF的治愈率。
