Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Thorac Cardiovasc Surg. 2010 Jan;139(1):111-7. doi: 10.1016/j.jtcvs.2009.07.002. Epub 2009 Sep 9.
Efficacy of the maze procedure for atrial fibrillation associated with advanced mitral disease not amenable to repair has not been determined. This study investigated whether type of mitral surgery affects maze outcome.
From January 1999 to January 2007, a total of 435 patients underwent the maze procedure and concomitant mitral operation. Of these, 226 underwent mitral repair and 209 underwent mitral replacement.
Median follow-up was 40.6 months (0.4-111.3 months), with 25 deaths and 6 strokes. Nineteen patients did not regain normal sinus rhythm. There were no significant intergroup differences in survival, stroke incidence, or sinus rhythm restoration rate. Among 427 early survivors, 64 had late atrial fibrillation recurrence. Five-year atrial fibrillation-free rates were 80.9% + or - 3.7% in the repair group and 77.3% + or - 4.1% in the replacement group (P = .099). By multivariate analysis, age at surgery older than 60 years (P = .045), fine atrial fibrillation wave pattern (P = .033), and preoperative left atrial dimension greater than 60 mm (P = .019) were independent risk factors for atrial fibrillation recurrence, whereas type of mitral surgery was not (P = .573). Although transmitral A-wave prevalence did not differ significantly between groups beyond the early postoperative period, A-wave velocity was faster in the repair group through the entire postoperative period (P < .001).
Maze outcomes were acceptable regardless of type of mitral surgery. Late atrial fibrillation recurrence was mainly affected by age, unfavorable electrocardiographic characteristics of atrial fibrillation, and larger preoperative left atrial size.
对于无法修复的晚期二尖瓣疾病合并心房颤动，迷宫手术的疗效尚不确定。本研究旨在探讨二尖瓣手术类型是否影响迷宫手术结果。
1999 年 1 月至 2007 年 1 月，共有 435 例行迷宫手术和同期二尖瓣手术的患者。其中 226 例行二尖瓣修复术，209 例行二尖瓣置换术。
中位随访时间为 40.6 个月（0.4-111.3 个月），共有 25 例死亡和 6 例中风。19 例患者未恢复正常窦性心律。各组间生存率、中风发生率和窦性心律恢复率无显著差异。在 427 例早期幸存者中，64 例出现晚期心房颤动复发。修复组和置换组的 5 年无心房颤动生存率分别为 80.9%+/-3.7%和 77.3%+/-4.1%（P=0.099）。多因素分析显示，手术时年龄大于 60 岁（P=0.045）、细心房颤动波模式（P=0.033）和术前左心房内径大于 60mm（P=0.019）是心房颤动复发的独立危险因素，而二尖瓣手术类型不是（P=0.573）。尽管术后早期两组间经二尖瓣的 A 波流速无显著差异，但修复组整个术后期间 A 波流速均较快（P<0.001）。
无论二尖瓣手术类型如何，迷宫手术结果均尚可。晚期心房颤动复发主要受年龄、不利的心房颤动心电图特征和较大的术前左心房大小的影响。
