Tamai J, Kosakai Y, Yoshioka T, Ohnishi E, Takaki H, Okano Y, Kawashima Y
Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Circulation. 1995 May 1;91(9):2392-9. doi: 10.1161/01.cir.91.9.2392.
Although the Maze procedure successfully restores sinus rhythm in patients with heart disease and atrial fibrillation, it is still uncertain whether an addition of the Maze procedure in cardiac surgery is beneficial for exercise performance of the patients after surgery.
The Maze procedure was performed in 25 patients (age, 37 to 70 years) during valve surgery (18 patients) or closure of atrial septal defect (7 patients). A cardiopulmonary exercise test using ramp incremental protocol (15 W/min) was performed before and 1 month, 6 months, and 1 year after surgery. Sinus conversion was obtained in 23 of 25 patients 1 month after surgery. However, sinoatrial (SA) node response to exercise was attenuated by surgery: Mean heart rate (HR) was 83 +/- 13/min at rest, 94 +/- 13/min at 60 W, and 107 +/- 17/min at peak exercise. Peak oxygen uptake (PVO2) was unchanged at this period (before, 17.6 +/- 4.5 mL.min-1.kg-1; 1 month after, 17.5 +/- 4.2 mL.min-1.kg-1). Thereafter, SA node response was restored 6 months after surgery: Mean HR was 84 +/- 13/min at rest, 104 +/- 16/min at 60 W, and 130 +/- 20/min at peak exercise (P < .01 versus 1 month). PVO2 was also improved at this period (20.7 +/- 4.0 mL.min-1.kg-1, P < .01). The increase in PVO2 from 1 month to 6 months after surgery was correlated with the increase in peak HR (y = 0.73x +/- 3.6, r = .79). There were no further changes in heart rate response or PVO2 from 6 months to 1 year after surgery.
Atrial fibrillation was successfully treated by combined treatment with surgical repair for organic heart disease and the Maze procedure. However, SA node response to exercise was attenuated early after surgery. Thus, exercise capacity was improved at the late phase after surgery, which was related to the extent of restoration in SA node response.
尽管迷宫手术能成功恢复心脏病合并心房颤动患者的窦性心律，但心脏手术中加做迷宫手术对患者术后运动能力是否有益仍不明确。
25例患者（年龄37至70岁）在瓣膜手术（18例）或房间隔缺损修补术（7例）期间接受了迷宫手术。术前以及术后1个月、6个月和1年采用斜坡递增方案（15瓦/分钟）进行心肺运动试验。术后1个月，25例患者中有23例实现了窦性心律转变。然而，手术使窦房（SA）结对运动的反应减弱：静息时平均心率（HR）为83±13次/分钟，60瓦时为94±13次/分钟，运动峰值时为107±17次/分钟。在此期间，峰值摄氧量（PVO2）无变化（术前为17.6±（此处原文可能有误，推测为4.5）毫升·分钟-1·千克-1；术后1个月为17.5±4.2毫升·分钟-1·千克-1）。此后，术后6个月窦房结反应恢复：静息时平均心率为84±13次/分钟，60瓦时为104±16次/分钟，运动峰值时为130±20次/分钟（与术后1个月相比，P<.01）。此期间PVO2也有所改善（20.7±4.0毫升·分钟-1·千克-1，P<.01）。术后1个月至6个月PVO2的增加与峰值心率的增加相关（y = 0.73x±3.6，r =.79）。术后6个月至1年，心率反应或PVO2无进一步变化。
通过器质性心脏病手术修复与迷宫手术联合治疗成功治愈了心房颤动。然而，术后早期窦房结对运动的反应减弱。因此，术后晚期运动能力得到改善，这与窦房结反应的恢复程度有关。
