Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease
Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease
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DOI：
10.1067/mtc.2002.124392
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发表时间：
2002-09-01
影响因子：
6
通讯作者：
Kitamura, S
中科院分区：
文献类型：
--
作者：
Bando, K;Kobayashi, J;Kitamura, S
目的：我们试图确定是否考克斯迷宫程序提供额外的好处，房颤患者接受二尖瓣operations.Methods：1992年5月至2000年8月，我们进行了258考克斯迷宫程序与二尖瓣置换术（n = 147）或二尖瓣修复术（n = 1 - 11）。我们将这些患者的结局与61例术前房颤的对照患者进行了比较，这些患者在相同的时间间隔内仅接受了二尖瓣置换术。三个队列在年龄、性别和术前纽约心脏协会心功能3级或4级的患者比例方面相似。尽管各组的5年生存率相似，（单纯二尖瓣置换术为94%，二尖瓣置换术加迷宫术为95%，二尖瓣修复术加迷宫术为97%），5年时，二尖瓣置换加迷宫组（78%）和二尖瓣修复加迷宫组（81%）的房颤自由率显著高于二尖瓣置换组（6%，P <0.0001）。二尖瓣置换术加迷宫组5年时卒中自由率为97%，二尖瓣修复术加迷宫组为97%，二尖瓣置换术组仅为79%（P < .0001）。考克斯风险模型的多变量分析显示，晚期卒中最显著的危险因素是遗漏了考克斯迷宫手术（P = .003）。结论：二尖瓣修复和置换术中增加考克斯迷宫手术对选定的患者安全有效。消除房颤显著降低了晚期卒中的发生率。
Objective: We sought to determine whether the Cox maze procedure provides additional benefit to patients with atrial fibrillation undergoing mitral valve operations.Methods: Between May 1992 and August 2000, we performed 258 Cox maze procedures with mitral valve replacement (n = 147) or mitral valve repair (n = 1 11). We compared the outcomes of these patients with those of 61 control patients with preoperative atrial fibrillation who underwent mitral valve replacement alone during the same interval. The three cohorts were similar in age, sex, and proportion of patients in preoperative New York Heart Association functional class 3 or 4.Results: Although 5-year survivals were similar among the groups (94% for mitral valve replacement alone, 95% for mitral valve replacement plus maze, and 97% for mitral valve repair plus maze), freedoms from atrial fibrillation at 5 years were significantly higher in the mitral valve replacement plus maze group (78%) and the mitral valve repair plus maze group (81%) than in the mitral valve replacement group (6%, P < .0001). Freedoms from stroke at 5 years were 97% for the mitral valve replacement plus maze group, 97% for the mitral valve repair plus maze group, and only 79% for mitral valve replacement group (P < .0001). Multivariable analysis with Cox hazard model revealed that the most significant risk factor for late stroke was the omission of the Cox maze procedure (P = .003).Conclusions: The addition of the Cox maze procedure to mitral valve repair and replacement was safe and effective for selected patients. Elimination of atrial fibrillation significantly decreased the incidence of late stroke.