Albrecht Alvaro, Kalil Renato A K, Schuch Luciana, Abrahão Rogério, Sant'Anna Joao Ricardo M, de Lima Gustavo, Nesralla Ivo A
Department of Cardiovascular Surgery, Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
J Thorac Cardiovasc Surg. 2009 Aug;138(2):454-9. doi: 10.1016/j.jtcvs.2009.04.023.
Chronic permanent atrial fibrillation is often due to mitral valve disease. The Cox maze procedure is the gold standard for treating this arrhythmia. Simpler techniques and ablation methods should have their efficacy tested in clinical practice. Our objective was to evaluate the effectiveness of surgical pulmonary vein isolation as compared with the Cox maze procedure.
Sixty patients were randomly assigned to control group, modified maze group (Cox maze III), and surgical isolation of the pulmonary veins (SPVI) group from July 1999 to October 2004. All patients had mitral valve lesions treated concomitantly. Preoperative characteristics were similar between groups.
There were 4 deaths: 3 in the Cox maze group and 1 in the SPVI group (P = .31). The Cox maze group presented longer times of extracorporeal circulation and myocardial ischemia (P < .001). The relative risk of late postoperative development of atrial fibrillation was 0.07 in the SPVI group (P < .001; 95% confidence intervals: 0.02-0.27) and 0.195 in the Cox maze group (P = .002; 95% confidence intervals: 0.07-0.56) as compared with the control group. No difference was found between the SPVI and Cox maze groups concerning prevention of atrial fibrillation recurrence (relative risk: 0.358; P = .215; 95% confidence intervals: 0.08-1.67).
The modified Cox maze procedure and surgical pulmonary vein isolation were similarly effective in restoring sinus or regular rhythm in permanent atrial fibrillation associated with mitral valve disease. These results favor the adoption of surgical isolation as a preferable technique, simpler and equally effective in controlling atrial fibrillation. The results also can bring further information for understanding the mechanisms involved in origins and treatment of chronic permanent atrial fibrillation.
慢性永久性心房颤动常由二尖瓣疾病引起。Cox迷宫手术是治疗这种心律失常的金标准。更简单的技术和消融方法应在临床实践中测试其疗效。我们的目的是评估手术肺静脉隔离与Cox迷宫手术相比的有效性。
从1999年7月至2004年10月，60例患者被随机分配至对照组、改良迷宫组（Cox迷宫III型）和手术肺静脉隔离（SPVI）组。所有患者均同时接受二尖瓣病变治疗。各组术前特征相似。
有4例死亡：Cox迷宫组3例，SPVI组1例（P = 0.31）。Cox迷宫组体外循环和心肌缺血时间更长（P < 0.001）。与对照组相比，SPVI组术后晚期发生心房颤动的相对风险为0.07（P < 0.001；95%置信区间：0.02 - 0.27），Cox迷宫组为0.195（P = 0.002；95%置信区间：0.07 - 0.56）。在预防心房颤动复发方面，SPVI组和Cox迷宫组之间未发现差异（相对风险：0.358；P = 0.215；95%置信区间：0.08 - 1.67）。
改良Cox迷宫手术和手术肺静脉隔离在恢复与二尖瓣疾病相关的永久性心房颤动的窦性或规则节律方面同样有效。这些结果支持采用手术隔离作为一种更可取的技术，其在控制心房颤动方面更简单且同样有效。这些结果也可为理解慢性永久性心房颤动的起源和治疗所涉及的机制带来更多信息。
