Cox J L, Gallagher J J, Cain M E
J Thorac Cardiovasc Surg. 1985 Oct;90(4):490-501.
Between July 1, 1980, and April 1, 1985, 118 patients underwent operation for correction of the Wolff-Parkinson-White syndrome. There were 72 male and 46 female patients with ages ranging from 9 months to 70 years (mean 28 +/- 6 years). The major indications for operation were medical refractoriness or drug intolerance (60%) and previous cardiac arrest (14%). Associated abnormalities included Ebstein's anomaly (12%), other arrhythmias (34%), coronary artery disease (6%), cardiomyopathy (6%), and congenital heart disease other than Ebstein's anomaly (22%). Two patients had undergone operations for Wolff-Parkinson-White syndrome previously at other institutions. Twenty percent of patients had multiple (two to four) accessory pathways, a total of 149 pathways being present in the 118 patients. Distribution of the accessory pathways was as follows: 58% left free wall, 24% posterior septal, 13% right free wall, and 5% anterior septal. The surgical technique employed previously for the Wolff-Parkinson-White syndrome and for the first 10 patients in the present series was modified in August, 1981, to include 2.5 power optical magnification, exclusive use of the endocardial approach under cardioplegic arrest, wider margins of surgical dissection, sharp dissection of the involved valve anulus, division of only the ventricular insertion of the accessory pathway, and internal identification of the ventricular epicardial peel in all regions of dissection. Of the 149 accessory pathways present, 148 were successfully divided in the 118 patients and, by means of the above modifications, 137 of 137 accessory pathways have been divided successfully in the last 108 patients in the series. The surgical results in these patients document an increase in the success rate for division of accessory pathways from 86% to 99.3%, a decrease in the reoperation rate from approximately 15% to 0%, and a decrease in the incidence of permanent complete heart block from 10.5% to 0.8%. The mortality was 5.0% in the entire series, but only one death occurred following elective operation in the absence of associated cardiac abnormalities (0.8%). Using the present surgical technique, these results suggest that surgical therapy is a conservative alternative to a lifetime of medical therapy in young, otherwise healthy patients with the Wolff-Parkinson-White syndrome.
1980年7月1日至1985年4月1日期间，118例患者接受了手术治疗以纠正预激综合征。其中男性72例，女性46例，年龄从9个月至70岁不等（平均28±6岁）。手术的主要指征是药物治疗无效或不耐受（60%）以及既往心脏骤停（14%）。合并的异常情况包括埃布斯坦畸形（12%）、其他心律失常（34%）、冠状动脉疾病（6%）、心肌病（6%）以及除埃布斯坦畸形外的先天性心脏病（22%）。2例患者曾在其他机构接受过预激综合征手术。20%的患者有多处（2至4处）附加旁道，118例患者共有149条旁道。旁道分布如下：左游离壁58%，后间隔24%，右游离壁13%，前间隔5%。先前用于预激综合征的手术技术以及本系列前10例患者所采用的技术于1981年8月进行了改进，包括使用2.5倍光学放大、在心脏停搏下仅采用心内膜入路、更宽的手术分离边缘、锐性分离受累瓣膜瓣环、仅切断附加旁道的心室端以及在所有分离区域内对心室心外膜进行内部识别。在118例患者中存在的149条附加旁道中，148条被成功切断，通过上述改进，本系列最后108例患者中的137条附加旁道均被成功切断。这些患者的手术结果表明，附加旁道切断成功率从86%提高到99.3%，再次手术率从约15%降至0%，永久性完全性心脏传导阻滞发生率从10.5%降至0.8%。整个系列的死亡率为5.0%，但在无相关心脏异常的择期手术后仅发生1例死亡（0.8%）。采用目前的手术技术，这些结果表明，对于年轻、无其他健康问题的预激综合征患者，手术治疗是终身药物治疗的一种保守替代方法。
