Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Ann Thorac Surg. 2020 Jan;109(1):124-131. doi: 10.1016/j.athoracsur.2019.05.061. Epub 2019 Jul 17.
The study sought to assess the long-term outcomes of the stand-alone Cox-Maze IV procedure in symptomatic patients with refractory, persistent, or long-standing persistent atrial fibrillation (AF).
Fifty-nine consecutive patients (mean age 52 ± 10.5 years, previous catheter ablation 80%, left ventricular ejection fraction 55% ± 3.4%, median left atrial volume index 41 [interquartile range, 34-47] mL/m) with symptomatic, refractory, persistent (56%), or longstanding persistent (44%) AF, underwent stand-alone Cox-Maze IV procedure. Biatrial ablations were performed with bipolar radiofrequency and cryoenergy. Left atrial appendage was excluded in 56 of 59 (95%) patients.
No hospital deaths occurred and 1 (1.7%) patient required postoperative pacemaker implantation. Follow-up was 97% complete (median 5.8 [interquartile range, 3.92-7.11] years). The overall survival at 7 years was 97% ± 2.3%. The 7-year cumulative incidence function of AF recurrence and of AF recurrence off class I or III antiarrhythmic drugs (AADs), with death as competing risk, was 14.2% ± 5.6% (95% confidence interval [CI], 5.5%-26.8%) and 26.5% ± 6.9% (95% CI, 14.2%-40.4%), respectively. Multivariate analysis identified the duration of AF as the only predictor of AF recurrence (hazard ratio, 1.01; 95% CI, 1.01-1.02; P < .001). At 7 years, the proportion of patients in sinus rhythm was 84%, of whom 74% were off class I or III AADs. At the last follow-up, 75% of patients were in European Heart Rhythm Association functional class I, no stroke and thromboembolic events were documented, and 70% of patients were off anticoagulation therapy. Left ventricular ejection fraction improved from 53% ± 3.4% at baseline to 59% ± 3.4% at follow-up (P = .003).
This study confirmed the safety and efficacy in the long term (7 years) of the stand-alone Cox-Maze IV surgical procedure for persistent or long-standing persistent AF. Indeed, more than 70% of the patients were in sinus rhythm off class I or III AADs and off oral anticoagulation.
本研究旨在评估孤立性 Cox-Maze IV 手术在有症状、药物难治性、持续性或长程持续性心房颤动（房颤）患者中的长期结局。
59 例连续患者（平均年龄 52±10.5 岁，既往导管消融 80%，左心室射血分数 55%±3.4%，中位数左心房容积指数 41[四分位距 34-47]mL/m2）患有有症状的、药物难治性（56%）或长程持续性（44%）房颤，接受了孤立性 Cox-Maze IV 手术。双极射频和冷冻能量进行双心房消融。59 例患者中的 56 例（95%）排除了左心耳。
无院内死亡，1 例（1.7%）患者术后需植入起搏器。随访 97%完整（中位数 5.8[四分位距 3.92-7.11]年）。7 年总生存率为 97%±2.3%。房颤复发和房颤复发（I 类或 III 类抗心律失常药物[AAD]）的 7 年累积发生率函数，以死亡为竞争风险，分别为 14.2%±5.6%（95%置信区间[CI]，5.5%-26.8%）和 26.5%±6.9%（95%CI，14.2%-40.4%）。多变量分析确定房颤持续时间是房颤复发的唯一预测因素（风险比，1.01；95%CI，1.01-1.02；P<.001）。7 年时，窦性心律患者比例为 84%，其中 74%停用 I 类或 III 类 AAD。在最后一次随访时，75%的患者处于欧洲心脏病学会功能分类 I 级，无卒中或血栓栓塞事件发生，70%的患者停止抗凝治疗。左心室射血分数从基线时的 53%±3.4%改善至随访时的 59%±3.4%（P=0.003）。
本研究证实了孤立性 Cox-Maze IV 手术治疗持续性或长程持续性房颤的长期（7 年）安全性和有效性。事实上，超过 70%的患者停用 I 类或 III 类 AAD 且停用口服抗凝剂后仍维持窦性心律。
