Musci M, Pasic M, Siniawski H, Lehmkuhl H, Edelmann B, Hetzer R
Abt. Herz-, Thorax-und Gefässchirurgie, Deutsches Herzzentrum Berlin.
Z Kardiol. 1998 Mar;87(3):202-8. doi: 10.1007/s003920050172.
Atrial fibrillation is associated with significant morbidity and mortality. The increased risk of thromboembolism makes constant anti-coagulation necessary, while the absence of atrial contraction worsens the hemodynamic situation. In this study we examined the results of simultaneous surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" while mitral valve surgery and atrial septal closure.
Between February 1995 and July 1997 sixteen patients aged 50 to 72 y (mean: 59 y) underwent open heart surgery (mitral valve replacement n = 10, reconstruction n = 3; mitral valve reconstruction and atrial septal closure n = 1, atrial septal closure n = 1, thrombectomy from left atrium n = 1) and "Cox/Maze-III-procedure" in one session. Preoperative duration of chronic atrial fibrillation was between 2 and 12 y (mean: 5.0 y). The patients were examined preoperatively and postoperatively 3, 6, 12, and 24 months after surgery using the following methods: transesophageal echocardiography (TEE), ECG, long-term ECG, and stress ergometry.
During the early postoperative period (< 7 d) all of the patients were in sinus rhythm or atrial pacing; eight patients intermittently had atrial fibrillation. In the follow-up period from 1 to 27 months (mean 14 months), 15 patients have a stable sinus rhythm (94%). One patient, preoperatively known to have intermittent tachybradycardia, received a pacemaker 2 months postoperatively for sinus bradycardia. Postoperatively in TEE patients showed left atrial contraction with improvement of hemodynamic situation. Stress ergometry 6 months postoperatively showed lower increasements of heart rate, at 12 months normal frequency.
The surgical treatment of chronic atrial fibrillation through "Cox/Maze-III-procedure" can be performed combined with other heart operations without increased perioperative or postoperative risks. The Maze-procedure is an effective surgical therapy of chronic atrial fibrillation. Postoperatively there is an improvement of the hemodynamic situation because of sinus rhythm and synchrone atrioventricular contraction.
心房颤动与显著的发病率和死亡率相关。血栓栓塞风险的增加使得持续抗凝成为必要，而心房收缩的缺失会使血流动力学状况恶化。在本研究中，我们检查了通过“Cox/迷宫III手术”同时进行二尖瓣手术和房间隔闭合术治疗慢性心房颤动的结果。
1995年2月至1997年7月期间，16例年龄在50至72岁（平均59岁）的患者接受了心脏直视手术（二尖瓣置换术10例，重建术3例；二尖瓣重建术和房间隔闭合术1例，房间隔闭合术1例，左心房血栓切除术1例），并同期进行了“Cox/迷宫III手术”。慢性心房颤动的术前持续时间为2至12年（平均5.0年）。使用以下方法在术前以及术后3、6、12和24个月对患者进行检查：经食管超声心动图（TEE）、心电图、动态心电图和运动负荷试验。
术后早期（<7天），所有患者均处于窦性心律或心房起搏状态；8例患者间歇性出现心房颤动。在1至27个月（平均14个月）的随访期内，15例患者维持稳定的窦性心律（94%）。1例术前已知有间歇性心动过缓的患者，术后2个月因窦性心动过缓接受了起搏器植入。术后TEE显示患者左心房收缩，血流动力学状况改善。术后6个月运动负荷试验显示心率增加幅度较低，12个月时频率正常。
通过“Cox/迷宫III手术”治疗慢性心房颤动可与其他心脏手术联合进行，而不会增加围手术期或术后风险。迷宫手术是治疗慢性心房颤动的一种有效手术方法。术后由于窦性心律和同步房室收缩，血流动力学状况得到改善。
