Franciscan Health Indianapolis, Indianapolis, Indiana, USA.
Swedish Medical Center, Seattle, Washington, USA.
J Card Surg. 2022 Oct;37(10):3006-3013. doi: 10.1111/jocs.16777. Epub 2022 Jul 23.
Benefits of concomitant atrial fibrillation (AF) surgical treatment are well established. Cardiac societies support treating AF during cardiac surgery with a class I recommendation. Despite these guidelines, adoption has been inconsistent. We report results of routine performance of concomitant Cox-Maze IV (CMIV) from participating centers using a standardized, prospective registry.
Nine surgeons at four cardiac surgery programs enrolled 807 patients undergoing concomitant CMIV surgery over 12 years. Lesions were created using bipolar radiofrequency clamps and cryoablation probes. Follow-up occurred at 3- and 6-months, then annually for 3 years. Freedom from AF was defined as no episode >30 s of atrial arrhythmia.
Sixty-four percent of patients were male, mean age 69 years, mean left atrial size 4.6 cm, mean preoperative AF duration 4.0 years, mean EuroSCORE 6.4, and mean CHADS score 3.1. Thirty-day postoperative mortality and neurologic event rates were 3.3% and 1.3%, respectively. New pacemaker implant rate was 6.3%. Freedom from AF rates at 1- and 3-years stratified by preoperative AF type were: paroxysmal 94.6% and 87.5%, persistent 82.1% and 81.9%, and longstanding persistent 84.1% and 78.1%. At 3-year follow up, 84% of patients were off antiarrhythmic drugs and 74% of sinus rhythm patients were off oral anticoagulants.
Routine CMIV is safe and effective. Acceptable outcomes can be achieved across multiple centers and multiple operators even in a moderate risk patient population undergoing more complex procedures. Surgeons and institutions should be encouraged by all cardiac societies to adopt the CMIV procedure to maximize patient benefit.
同期治疗心房颤动（房颤）的益处已得到充分证实。心脏学会支持在心脏手术期间对房颤进行 I 类推荐。尽管有这些指南，但采用情况并不一致。我们报告了使用标准化、前瞻性登记处从参与中心常规进行同期 Cox-Maze IV（CMIV）手术的结果。
四位心脏外科医生在四个心脏外科项目中招募了 807 名同时接受 CMIV 手术的患者，共 12 年。使用双极射频夹和冷冻消融探针创建病变。在 3 个月和 6 个月时进行随访，然后每年随访 3 年。无房颤定义为无 >30s 的心房心律失常发作。
64%的患者为男性，平均年龄 69 岁，平均左心房大小为 4.6cm，平均术前房颤持续时间为 4.0 年，平均 EuroSCORE 为 6.4，平均 CHADS 评分为 3.1。术后 30 天死亡率和神经系统事件发生率分别为 3.3%和 1.3%。新起搏器植入率为 6.3%。根据术前房颤类型分层的 1 年和 3 年无房颤率为：阵发性 94.6%和 87.5%、持续性 82.1%和 81.9%、持久性 84.1%和 78.1%。在 3 年随访时，84%的患者停止使用抗心律失常药物，74%的窦性节律患者停止使用口服抗凝药物。
常规 CMIV 是安全有效的。即使在接受更复杂手术的中等风险患者群体中，也可以在多个中心和多个外科医生中实现可接受的结果。所有心脏学会都应鼓励外科医生和机构采用 CMIV 程序，以最大限度地提高患者的获益。
