Kosakai Y, Kawaguchi A T, Isobe F, Sasako Y, Nakano K, Eishi K, Tanaka N, Kito Y, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
J Thorac Cardiovasc Surg. 1994 Dec;108(6):1049-54; discussion 1054-5.
Between April 1992 and October 1993, we combined a modified maze procedure with mitral valve repair (n = 26) or replacement (n = 36) in 62 patients with atrial fibrillation, including 16 patients undergoing reoperation. Associated procedures included aortic valve operation (n = 22), tricuspid annuloplasty (n = 28), atrial plication (n = 10), and others (n = 3). Duration of atrial fibrillation varied from 0.1 to 23 years (average 8.3 +/- 6.4 years), the f-wave voltage ranged from 0 to 0.45 mV (0.16 +/- 0.09 mV), and cardiothoracic ratio varied from 46% to 85% (64% +/- 9%). We modified the maze atriotomies to preserve the sinus node artery and used cryoablation to simplify procedures. Aortic crossclamp time was 142 +/- 25 minutes and cardiopulmonary bypass time 226 +/- 34 minutes. No early or late deaths occurred in a total of 783 patient-months of follow-up. In 52 patients (84%) who regained atrial rhythm, an atrial A-wave was detected in 84% for transtricuspid flow and in 71% for transmitral flow. One patient with sinus rhythm had an episode of transient neurologic ischemia 4 months after mechanical valve implantation. The 10 patients who remained in atrial fibrillation had preoperative fibrillation for a significantly longer time than the rest of the patients with atrial rhythm (14.8 versus 7.2 years p < 0.001) and a larger left atrial dimension (70 versus 58 mm, p < 0.01). Nonetheless, no variable alone could have predicted postoperative rhythm for individual patients. The results suggest that the maze procedure is safe and effective and therefore should be considered for patients with chronic atrial fibrillation undergoing mitral valve operations.
1992年4月至1993年10月期间，我们对62例房颤患者实施了改良迷宫手术，并同期进行二尖瓣修复术（26例）或二尖瓣置换术（36例），其中包括16例再次手术患者。相关手术包括主动脉瓣手术（22例）、三尖瓣环成形术（28例）、心房折叠术（10例）以及其他手术（3例）。房颤持续时间为0.1至23年（平均8.3±6.4年），f波电压范围为0至0.45mV（0.16±0.09mV），心胸比率为46%至85%（64%±9%）。我们对迷宫心房切开术进行了改良以保留窦房结动脉，并采用冷冻消融术简化手术操作。主动脉阻断时间为142±25分钟，体外循环时间为226±34分钟。在总计783个患者月的随访中，未发生早期或晚期死亡。在恢复心房节律的52例患者（84%）中，经三尖瓣血流检测发现84%的患者存在心房A波，经二尖瓣血流检测发现71%的患者存在心房A波。1例窦性心律患者在机械瓣膜植入术后4个月发生了短暂性神经缺血发作。仍处于房颤状态的10例患者术前房颤持续时间明显长于其余恢复心房节律的患者（14.8年对7.2年，p<0.001），左心房内径更大（70mm对58mm，p<0.01）。尽管如此，没有任何单一变量能够预测个体患者的术后心律。结果表明，迷宫手术安全有效，因此对于接受二尖瓣手术的慢性房颤患者应考虑采用该手术。
