Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
J Thorac Cardiovasc Surg. 2017 May;153(5):1087-1094. doi: 10.1016/j.jtcvs.2016.12.034. Epub 2017 Jan 16.
Most patients with atrial fibrillation (AF) undergoing cardiac surgery do not receive concomitant ablation. This study reviewed outcomes of patients with AF undergoing Cox-maze IV (CMIV) procedure with radiofrequency and cryoablation and coronary artery bypass grafting (CABG) at our institution.
Between the introduction of radiofrequency ablation in 2002 and 2015, 135 patients underwent left- or biatrial CMIV with CABG. Patients undergoing other cardiac procedures, except mitral valve repair, or who had emergent, reoperative, or off-pump procedures were excluded. Eighty-three patients remained in the study group after exclusion criteria were applied. Freedom from atrial tachyarrhythmias (ATAs) was ascertained using electrocardiogram, Holter monitor, or pacemaker interrogation at 1 to 5 years postoperatively.
Operative mortality was 3%. Freedom from ATAs at 1 year in the CMIV group was 98%, with 88% off antiarrhythmia drugs. Freedom from ATAs and antiarrhythmia drugs was 70% at 5 years.
The addition of CMIV to CABG resulted in excellent freedom from ATAs at 1 to 5 years. These patients are at increased risk for nonfatal complications compared with others undergoing concomitant surgical ablation.
大多数接受心脏手术的心房颤动（AF）患者并未接受同期消融治疗。本研究回顾了我们机构中接受 Cox-maze IV（CMIV）手术联合射频和冷冻消融以及冠状动脉旁路移植术（CABG）的 AF 患者的结局。
在 2002 年引入射频消融术至 2015 年期间，共有 135 例患者接受了左心房或双心房 CMIV 联合 CABG。排除了接受其他心脏手术（二尖瓣修复除外）、急诊手术、再次手术或非体外循环手术的患者。排除标准适用后，83 例患者仍留在研究组。术后 1 至 5 年，通过心电图、动态心电图或起搏器询问确定心房快速性心律失常（ATAs）的无复发率。
手术死亡率为 3%。CMIV 组术后 1 年的 ATA 无复发率为 98%，88%的患者未服用抗心律失常药物。5 年时 ATA 和抗心律失常药物无复发率为 70%。
CMIV 联合 CABG 可使 1 至 5 年内 ATA 无复发率显著提高。与同期接受手术消融的患者相比，这些患者发生非致命性并发症的风险增加。
