Sakamoto Yoshimasa, Takakura Hiromitsu, Onoguchi Katsuhisa, Hachiya Takashi, Sasaki Tatsuumi, Yoshitake Michio, Hashimoto Kazuhiro
The Jikei University School of Medicine, Department of Cardiac Surgery, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(2):148-52. doi: 10.5761/atcs.oa.10.01560.
We evaluated medium-term results of the left-sided maze procedure using cryoablation in patients with valvular heart disease.
We retrospectively evaluated 111 patients with valvular heart disease who underwent the cryosurgical left-sided maze procedure. The mean follow-up period was 36.8 ± 24.9 months, and the mean duration of atrial fibrillation was 5.6 ± 6.0 years. The primary surgical procedure was mitral valve replacement in 42 patients, mitral valve plasty in 28, aortic valve replacement in 25, and combined aortic and mitral replacement or plasty in 16.
The 7-year actuarial survival rate was 82.9 ± 11.4% for patients in sinus rhythm and 87.0 ± 7.0% for patients with atrial fibrillation, showing no difference between the two groups (p = 0.236). At final follow-up, 86 out of 111 patients (77.5%) remained free from atrial fibrillation. Sinus rhythm was maintained in 26 of 42 patients (61.9%) in the mitral valve replacement group, 26 of 28 patients (92.9%) in the mitral valve plasty group, 15 of 17 patients (88.2%) in the aortic valve replacement group, and 18 of 24 patients (75.0%) in the combined aortic and mitral replacement or plasty group. The overall actuarial rate of freedom from atrial fibrillation at 5 years after surgery was 70.4 ± 6.0%.
The cryosurgical left-sided maze procedure is a safe, simple, and excellent operation for medically refractory atrial fibrillation.
我们评估了在心脏瓣膜病患者中使用冷冻消融进行左侧迷宫手术的中期结果。
我们回顾性评估了111例接受冷冻手术左侧迷宫手术的心脏瓣膜病患者。平均随访期为36.8±24.9个月，房颤平均持续时间为5.6±6.0年。主要手术方式为二尖瓣置换术42例，二尖瓣成形术28例，主动脉瓣置换术25例，主动脉瓣和二尖瓣联合置换或成形术16例。
窦性心律患者的7年预期生存率为82.9±11.4%，房颤患者为87.0±7.0%，两组之间无差异（p=0.236）。在最后一次随访时，111例患者中有86例（77.5%）未再发生房颤。二尖瓣置换组42例患者中有26例（61.9%）维持窦性心律，二尖瓣成形术组28例患者中有26例（92.9%），主动脉瓣置换组17例患者中有15例（88.2%），主动脉瓣和二尖瓣联合置换或成形术组24例患者中有18例（75.0%）。术后5年无房颤的总体预期发生率为70.4±6.0%。
冷冻手术左侧迷宫手术是一种治疗药物难治性房颤的安全、简单且出色的手术。
