Je Hyung Gon, Lee Jae Won, Jung Sung Ho, Choo Suk Jung, Song Hyun, Yun Sung Cheol, Chung Cheol Hyun
Department of Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Eur J Cardiothorac Surg. 2009 Aug;36(2):272-8; discussion 278-9. doi: 10.1016/j.ejcts.2009.02.058. Epub 2009 May 5.
Since the late 1980s, surgical ablation of atrial fibrillation (AF) has been one of the most effective means of curing this arrhythmia. However, about 20% of patients who underwent maze procedures have shown recurrence of AF during the follow-up periods. The aim of this study is to evaluate our result of maze procedures in last decade and to analyze the risk factors of maze failure.
Between July 1997 and July 2007, 560 consecutive patients underwent maze procedures for AF by a single surgeon. Demographics showed that average age of the patients is 51.3 years, with a slight female predominance (M:F = 248:312). Most of the maze procedures had been performed in conjunction with mitral valve (n = 494, 88.6%), while only six cases (1.1%) were performed with isolated maze procedure. The maze failure was defined as showing any rhythm besides normal sinus rhythm at the last follow-up. Univariate and multivariate analysis for the risk factors of maze failure were identified. The survival impact of maze failure was also evaluated.
The in-hospital mortality (1.6%) was acceptable. During the 29.7 months of median follow-up period, the late mortality rate was 3.8% and permanent pacemaker insertion was necessary in 2.3% (n = 13) of the patients. The success rate of maze was 84.1% (471/560) and effective left atrial contraction was identified in 97.2% (458/471) of these patients. In multivariate analysis, the size of left atrium larger than 60 mm, cardiothoracic ratio over 60%, fine AF wave in preoperative ECG, no early normal sinus restoration and simplified surgical ablation were found as an independent predictor of maze failure. Furthermore, the patients with successful maze showed better long-term survival rates.
The results of our maze procedure during the last decade showed an acceptable success rate and the patients who were restored to sinus rhythm after maze procedures showed better long-term survival rates. For the patients who have independent biological risk factors, more thorough ablation lesion set is recommended for better long-term results.
自20世纪80年代末以来，心房颤动（AF）的外科消融一直是治疗这种心律失常最有效的手段之一。然而，约20%接受迷宫手术的患者在随访期间出现房颤复发。本研究的目的是评估我们在过去十年中迷宫手术的结果，并分析迷宫手术失败的危险因素。
1997年7月至2007年7月，560例连续患者由同一外科医生进行迷宫手术治疗房颤。人口统计学显示，患者平均年龄为51.3岁，女性略占优势（男：女=248：312）。大多数迷宫手术是与二尖瓣手术联合进行的（n=494，88.6%），而仅6例（1.1%）是单独进行迷宫手术。迷宫手术失败定义为在最后一次随访时出现除正常窦性心律以外的任何心律。确定迷宫手术失败危险因素的单因素和多因素分析。还评估了迷宫手术失败对生存的影响。
住院死亡率（1.6%）可以接受。在中位随访期29.7个月期间，晚期死亡率为3.8%，2.3%（n=13）的患者需要植入永久性起搏器。迷宫手术成功率为84.1%（471/560），其中97.2%（458/471）的患者左心房有效收缩。多因素分析发现，左心房直径大于60mm、心胸比率超过60%、术前心电图房颤波细小、术后早期未恢复正常窦性心律以及简化手术消融是迷宫手术失败的独立预测因素。此外，迷宫手术成功的患者长期生存率更高。
我们过去十年迷宫手术的结果显示成功率可以接受，迷宫手术后恢复窦性心律的患者长期生存率更高。对于有独立生物学危险因素的患者，建议进行更彻底的消融灶设置以获得更好的长期效果。
