Duke University Medical Center, Durham, NC 27710, USA.
Cardiovasc Ther. 2010 Oct;28(5):311-26. doi: 10.1111/j.1755-5922.2010.00139.x.
Surgical or modified Maze procedures have been promoted to treat atrial fibrillation (AF); however, few randomized controlled clinical trials (RCTs) examine their outcomes. The purpose of this meta-analysis is to compare the efficacy of surgical Maze procedures performed concomitantly with referral cardiac surgery versus pharmacologic therapy for the treatment of AF. We searched MEDLINE, Cochrane database, FDA web-portal, and clinicaltrials.gov for all RCTs comparing surgical Maze procedures with medical therapy for sinus rhythm maintenance. Primary outcomes were either freedom from AF within 12 months postprocedure off antiarrhythmic drug (AAD), or freedom from AF while taking an AAD. Secondary outcomes included operative mortality, all-cause mortality, hospital length of stay, and postoperative complications. Both fixed- and random-effects models were used for a meta-analysis of 9 randomized controlled trials (n = 472, of which 249 underwent a Maze procedure and 213 underwent referral surgery alone). The surgical Maze procedure significantly increased the odds of freedom from AF within 12 months compared with cardiac surgery alone (OR 5.22, 95% CI 1.71-15.88). There was significant heterogeneity among the trials for freedom from AF (chi-square = 15.98 for 4 degrees of freedom, P= 0.003). Among the two studies that fully reported AAD use, there was no evidence of improved survival free from AF and AAD therapy (OR 1.78, 95% CI 0.73-4.34). Among patients with valvular AF, surgical Maze procedures are associated with a decrease in AF one year postprocedure without significant increase in mean length of hospital stay, perioperative complications, operative, or all-cause mortality. Large RCTs defining rates of freedom from AF without AADs postprocedure, are still needed to evaluate outcomes and determine the appropriate role for surgical Maze procedures in the management of AF.
外科或改良迷宫手术已被推广用于治疗心房颤动（AF）；然而，很少有随机对照临床试验（RCT）检查其结果。本荟萃分析的目的是比较同时进行心脏外科手术与药物治疗的外科迷宫手术治疗 AF 的疗效。我们检索了 MEDLINE、Cochrane 数据库、FDA 网络门户和 clinicaltrials.gov，以获取所有比较外科迷宫手术与药物治疗窦性心律维持的 RCT。主要结局是术后 12 个月停用抗心律失常药物（AAD）后无 AF 的比例，或服用 AAD 时无 AF 的比例。次要结局包括手术死亡率、全因死亡率、住院时间和术后并发症。对于 9 项随机对照试验（n = 472，其中 249 例接受迷宫手术，213 例单独接受转诊手术）的荟萃分析，使用固定效应和随机效应模型。与单独心脏手术相比，外科迷宫手术显著增加了 12 个月内无 AF 的几率（OR 5.22，95%CI 1.71-15.88）。对于无 AF 的几率，试验之间存在显著的异质性（卡方 = 15.98，自由度为 4，P = 0.003）。在两项充分报告 AAD 使用情况的研究中，无 AF 和 AAD 治疗的生存率无改善证据（OR 1.78，95%CI 0.73-4.34）。对于瓣膜性 AF 患者，外科迷宫手术可降低术后 1 年的 AF 发生率，而平均住院时间、围手术期并发症、手术或全因死亡率无显著增加。仍需要进行大型 RCT 以评估术后无 AAD 的 AF 缓解率，并确定外科迷宫手术在 AF 管理中的适当作用。
