Kobayashi J, Kosakai Y, Isobe F, Sasako Y, Nakano K, Eishi K, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
J Thorac Cardiovasc Surg. 1996 Nov;112(5):1216-21; discussion 1222. doi: 10.1016/S0022-5223(96)70134-4.
The frequency of reoperation for mitral valve diseases with chronic atrial fibrillation has increased steadily. This study examined the rationale for using the Cox maze operation for atrial fibrillation during redo mitral valve operations.
Between June 1992 and July 1995, we performed the maze procedure in 42 patients as a concomitant operation with redo mitral valve surgery (maze group). Associated procedures were tricuspid valve surgery in 27 patients and aortic valve surgery in 15 patients. The mean age at operation was 57.3 +/- 9.7 years, and the mean interval from the previous operation was 14.3 +/- 10.5 years. The mean follow-up period after the maze procedure was 25.5 +/- 10.8 months. Atrial fibrillation was present at the time of the previous operation in 29 patients (69%).
Neither hospital death nor late death occurred. Sinus rhythm was regained in 28 patients (67%), and an atrial A-wave was detected in 21 patients (50%) by pulsed Doppler study. Patients in whom sinus rhythm was restored had a shorter history of atrial fibrillation (9.0 +/- 6.0 years vs 15.9 +/- 4.6 years, p = 0.0009), a larger f-wave on lead V1 of the electrocardiogram (0.18 +/- 0.10 mV vs 0.10 +/- 0.08 mV, p = 0.017), and a smaller cardiothoracic ratio (63% +/- 8% vs 67% +/- 5%, p = 0.049) than patients with persistent atrial fibrillation. During the same period, 54 patients underwent mitral valve reoperation without the maze procedure (control group). The aortic crossclamp and cardiopulmonary bypass times were slightly longer (p = 0.048 and p = 0.012) in the maze group (133 +/- 28 minutes and 221 +/- 43 minutes) than in the control group (126 +/- 65 minutes and 197 +/- 78 minutes). There was no significant difference in the amount of chest tube drainage or transfusion between the two groups (890 +/- 510 ml and 2120 +/- 1600 ml, respectively, in the maze group and 840 +/- 480 ml and 2140 +/- 1760 ml, respectively, in the control group). It was not necessary to reopen the chest for bleeding significantly more often in one group than in the other (14% in the maze group and 7% in the control group), and it was possible to operate without transfusion with the same frequency in the two groups (17% in the maze group and 20% in the control group).
These results suggest that the maze procedure should be considered in selected patients who have a high possibility of regaining sinus rhythm during redo mitral valve operations.
二尖瓣疾病合并慢性心房颤动的再次手术频率一直在稳步上升。本研究探讨在二尖瓣再次手术期间使用Cox迷宫手术治疗心房颤动的理论依据。
1992年6月至1995年7月，我们对42例患者进行了迷宫手术，作为二尖瓣再次手术的同期手术（迷宫组）。相关手术包括27例三尖瓣手术和15例主动脉瓣手术。手术时的平均年龄为57.3±9.7岁，距上次手术的平均间隔时间为14.3±10.5年。迷宫手术后的平均随访期为25.5±10.8个月。29例患者（69%）在上次手术时存在心房颤动。
无住院死亡或晚期死亡发生。28例患者（67%）恢复窦性心律，21例患者（50%）经脉冲多普勒研究检测到心房A波。恢复窦性心律的患者心房颤动病史较短（9.0±6.0年对15.9±4.6年，p = 0.0009），心电图V1导联上的f波较大（0.18±0.10 mV对0.10±0.08 mV，p = 0.017），心胸比率较小（63%±8%对67%±5%，p = 0.049），与持续性心房颤动患者相比。同期，54例患者未行迷宫手术进行二尖瓣再次手术（对照组）。迷宫组的主动脉阻断和体外循环时间略长（p = 0.048和p = 0.012）（分别为133±28分钟和221±43分钟），而对照组分别为126±65分钟和197±78分钟。两组之间胸腔引流管引流量或输血量无显著差异（迷宫组分别为890±510 ml和2120±1600 ml，对照组分别为840±480 ml和2140±1760 ml）。一组因出血而再次开胸的频率并不比另一组显著更高（迷宫组为14%，对照组为7%），两组以相同频率进行无输血手术也是可能的（迷宫组为17%，对照组为20%）。
这些结果表明，对于在二尖瓣再次手术期间恢复窦性心律可能性较高的特定患者，应考虑迷宫手术。
