Meng Yanhai, Zhang Yanbo, Liu Ping, Zhu Changsheng, Lu Tao, Hu Enci, Yang Qiulan, Nie Changrong, Wang Shuiyun
Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Adult Cardiac Surgery, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Aug 2;8:720950. doi: 10.3389/fcvm.2021.720950. eCollection 2021.
Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. Ninety-four patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent septal myectomy were analyzed, we divided it into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox maze operation (no Cox-maze group). Freedom from atrial fibrillation recurrence and all-cause mortality after surgery were assessed. Freedom from all-cause mortality after septal myectomy at 1, 3, and 5 years was 98.5 ± 1.5% each in the Cox-maze group and 90.8 ± 6.3%, 85.1 ± 8.1%, and 85.1 ± 8.1%, respectively, in the no Cox-maze group. Patients in the no Cox-maze group had lower survival, freedom from atrial fibrillation recurrence off antiarrhythmic drugs, and arrhythmia control rate (including patients with successful antiarrhythmic drug conversion) than those in the Cox-maze group ( = 0.046, = 0.040, and = 0.012, respectively). Patients who underwent the Cox-maze IV procedure had lower atrial fibrillation recurrence rate than those who did not (hazard ratio, 0.141; 95% confidence interval, 0.042-0.479; = 0.002). Post-operative increases in left atrial diameters (hazard ratio, 1.099; 95% confidence interval, 1.024-1.179; = 0.009) were associated with atrial fibrillation recurrence. The Cox-maze IV procedure combined with septal myectomy improved mid-term survival and reduced mid-term atrial fibrillation recurrence in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. The concomitant Cox-maze IV procedure was associated with a lower atrial fibrillation recurrence in patients with surgical hypertrophic obstructive cardiomyopathy and atrial fibrillation.
心房颤动是肥厚性梗阻性心肌病患者中最常见的持续性心律失常。关于有或没有手术消融的室间隔心肌切除术的安全性和有效性的比较分析有限。本研究旨在比较肥厚性梗阻性心肌病合并心房颤动患者接受或不接受Cox迷宫IV手术的室间隔心肌切除术的结果。分析了94例接受室间隔心肌切除术的肥厚性梗阻性心肌病合并心房颤动患者，将其分为同期Cox迷宫手术组（Cox迷宫组）和非同期Cox迷宫手术组（非Cox迷宫组）。评估术后无房颤复发和全因死亡率。Cox迷宫组室间隔心肌切除术后1年、3年和5年的全因死亡率分别为98.5±1.5%，非Cox迷宫组分别为90.8±6.3%、85.1±8.1%和85.1±8.1%。非Cox迷宫组患者的生存率、停用抗心律失常药物后的无房颤复发率和心律失常控制率（包括抗心律失常药物转复成功的患者）低于Cox迷宫组（分别为P = 0.046、P = 0.040和P = 0.012）。接受Cox迷宫IV手术的患者房颤复发率低于未接受该手术的患者（风险比，0.141；95%置信区间，0.042 - 0.479；P = 0.002）。术后左心房直径增加（风险比，1.099；95%置信区间，1.024 - 1.179；P = 0.009）与房颤复发相关。Cox迷宫IV手术联合室间隔心肌切除术可改善肥厚性梗阻性心肌病合并心房颤动患者的中期生存率并降低中期房颤复发率。同期Cox迷宫IV手术与肥厚性梗阻性心肌病手术合并心房颤动患者较低的房颤复发相关。
