Patwardhan A M, Dave H H, Tamhane A A, Pandit S P, Dalvi B V, Golam K, Kaul A, Chaukar A P
Department of Cardiovascular and Thoracic Surgery, LTMM College and LTMG Hospital, Sion, Mumbai, India.
Eur J Cardiothorac Surg. 1997 Oct;12(4):627-33. doi: 10.1016/s1010-7940(97)00222-4.
Radiofrequency catheter ablation of atrial tachycardias and flutter is an established technique. The same modality in the microbipolar mode is effective in producing full thickness coagulation injury. Cox's maze procedure is highly successful in curing atrial fibrillation (AF) surgically. However, it consumes relatively long cross clamp time and cardiopulmonary bypass time. In this study, radiofrequency microbipolar coagulation was used as an adjunct to corrective valve surgery, as an intraoperative ablative modality to replace Cox's maze III incisions, thus remarkably shortening the procedure. The results of this procedure are compared historically with those of 26 patients who underwent corrective valve surgery alone.
Radiofrequency microbipolar coagulation was used to produce conduction blocks along the Cox's maze III incision lines as an adjunct to valve surgery in 18 patients in atrial fibrillation undergoing surgery for rheumatic valvular disease. A bayonet type bipolar forceps with an active tip length of 7 mm drawing current from a microbipolar port of Valleylab Force 4 electrosurgical unit (Valleylab, Boulder, CO) was used for microbipolar coagulation. A 3-mm retinal handheld cryoprobe working on nitrous oxide gas was used for cryoablation.
A total of 15 survivors in the coagulation maze group were followed from 43 to 224 days (149.7 +/- 73.1 mean +/- S.D.). Twelve of the 15 survivors (80%) converted to normal sinus rhythm (70% confidence limit: 64.7-90.6%). Atrial transport function studies with pulsed wave doppler, showed presence of a wave in all the 12 (100%) patients in tricuspid valve flow and in nine (75%) patients in mitral valve flow. The procedure took 11.62 +/- 3.86 min of elective cardioplegic arrest time for the left atrial portion and 18.71 +/- 4.25 min of cardiopulmonary bypass time during reperfusion for the right atrial portion. Of the 23 survivors out of 26 patients who underwent the valve procedure alone, only one patient (4.3%) converted to normal sinus rhythm (70% confidence limit: 0.6-14%).
Thus, our modification considerably shortened the time taken for creating the maze in comparison to the Cox's maze procedure and was effective in restoring normal sinus rhythm in 80% of the patients.
射频导管消融房性心动过速和心房扑动是一项成熟的技术。微双极模式下的相同方法能有效产生全层凝固性损伤。考克斯迷宫手术在外科治疗心房颤动（AF）方面非常成功。然而，它消耗的交叉钳夹时间和体外循环时间相对较长。在本研究中，射频微双极凝固被用作矫正瓣膜手术的辅助手段，作为一种术中消融方式来替代考克斯迷宫III型切口，从而显著缩短手术时间。将该手术的结果与26例仅接受矫正瓣膜手术的患者的历史结果进行比较。
在18例因风湿性瓣膜病接受手术的心房颤动患者中，使用射频微双极凝固沿着考克斯迷宫III型切口线产生传导阻滞，作为瓣膜手术的辅助手段。使用一种刺刀型双极钳，其有效尖端长度为7mm，从Valleylab Force 4电外科设备（Valleylab，博尔德，科罗拉多州）的微双极端口吸取电流进行微双极凝固。使用一种以一氧化二氮气体为动力的3mm视网膜手持式冷冻探头进行冷冻消融。
凝固迷宫组共有15名幸存者，随访时间为43至224天（平均149.7±73.1天，标准差）。15名幸存者中有12名（80%）转为正常窦性心律（70%置信区间：64.7 - 90.6%）。用脉冲波多普勒进行的心房运输功能研究显示，所有12名（100%）患者的三尖瓣血流中有a波，9名（75%）患者的二尖瓣血流中有a波。左心房部分的选择性心脏停搏时间为11.62±3.86分钟，右心房部分再灌注期间的体外循环时间为18.71±4.25分钟。在26例仅接受瓣膜手术的患者中，23名幸存者中只有1例（4.3%）转为正常窦性心律（70%置信区间：0.6 - 14%）。
因此，与考克斯迷宫手术相比，我们的改良方法显著缩短了创建迷宫所需的时间，并且在80%的患者中有效恢复了正常窦性心律。
