Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Circulation. 2012 May 1;125(17):2071-80. doi: 10.1161/CIRCULATIONAHA.111.082347. Epub 2012 Mar 28.
The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear.
We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation-associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65-2.03; P=0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50-1.34; P=0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12-0.73; P=0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2-149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0-3) subgroup (P=0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup (P=0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular (P<0.001) and tricuspid valvular functions (P<0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0-146.8 months) after surgery.
Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.
对于已经需要终身抗凝治疗的慢性心房颤动患者，在接受机械瓣膜置换术时行迷宫手术的长期益处尚不清楚。
我们评估了 1999 年至 2010 年间 569 例因心房颤动相关瓣膜病而行机械瓣膜置换术的患者的不良结局（死亡；血栓栓塞事件；死亡、心力衰竭或瓣膜相关并发症的复合事件），其中 317 例（n=317）患者同期行迷宫手术，252 例（n=252）患者单纯行瓣膜置换术。在调整了基线风险特征的差异后，行迷宫手术的患者在死亡（危险比，1.15；95%置信区间，0.65-2.03；P=0.63）和复合结局（危险比，0.82；95%置信区间，0.50-1.34；P=0.42）方面的风险相似，但血栓栓塞事件的风险显著降低（危险比，0.29；95%置信区间，0.12-0.73；P=0.008）。中位随访 63.6 个月（范围 0.2-149.9 个月）时，与单纯行瓣膜置换术相比。在低危欧洲心脏手术风险评分（0-3）亚组中，同期行迷宫手术的无事件生存获益显著（P=0.049），但在高危欧洲心脏手术风险评分（≥4）亚组中无显著差异（P=0.65）。此外，与单纯行瓣膜置换术相比，在中位随访 52.7 个月（范围 6.0-146.8 个月）时，同期行迷宫手术可改善左心室（P<0.001）和三尖瓣瓣膜功能（P<0.001）。
与单纯行瓣膜置换术相比，机械瓣膜置换术同期行迷宫手术可降低血栓栓塞并发症风险，改善血流动力学，尤其对于手术风险较低的患者。
