A minimally invasive cox-maze procedure: operative technique and results.
A minimally invasive cox-maze procedure: operative technique and results.
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DOI：
10.1097/imi.0b013e3181ee3815
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发表时间：
2010-07
期刊：
影响因子：
--
通讯作者：
Damiano RJ Jr
中科院分区：
文献类型：
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作者：
Lee AM;Clark K;Bailey MS;Aziz A;Schuessler RB;Damiano RJ Jr
传统上，用于心房颤动手术治疗的 Cox-Maze 手术需要进行正中胸骨切开术和体外循环。本研究描述了一种使用消融技术通过 5-6 厘米右侧小型胸廓切开术创建完整 Cox 迷宫病灶的方法。连续 22 名患者通过右侧小胸廓切开术和体外循环接受了 Cox-Maze 手术。所有患者均在 3、6 和 12 个月时通过心电图和 24 小时动态心电图监测进行前瞻性随访。 Cox-Maze 手术损伤组是使用双极射频能量和冷冻疗法创建的。没有手术死亡或重大并发症。两名患者需要永久起搏器。 5 名患者 (23%) 患有早期房性快速心律失常。在最后一次随访（平均 18 ± 12 个月）时，所有患者 (n=22) 均未出现房性心律失常。 3 个月时 (n=19)，84% 的患者停止服用抗心律失常药物。到 6 个月时 (n=18)，94% 的患者不再出现房颤，也不再服用抗心律失常药物。 12 个月时 (n=16)，81% 的患者不再出现房颤且不再服用抗心律失常药物，三名患者仍在使用华法林进行机械二尖瓣治疗。完整的考克斯迷宫手术可以通过右侧小型胸廓切开术进行，并具有出色的短期效果。这种侵入性较小的手术可以在不影响疗效的情况下提供给患者。
The Cox-Maze procedure for the surgical treatment of atrial fibrillation traditionally has required a median sternotomy and cardiopulmonary bypass. This study describes a method using ablation technologies to create the full Cox-Maze lesion set through a 5–6 cm right mini-thoracotomy. Twenty-two consecutive patients underwent a Cox-Maze procedure via a right mini-thoracotomy and cardiopulmonary bypass. All patients were followed prospectively with ECG and 24 hour Holter monitoring at 3, 6, and 12 months. The Cox-Maze procedure lesion set was created using bipolar radiofrequency energy and cryothermy. There was no operative mortality or major complications. Two patients required a permanent pacemaker. Five patients (23%) had early atrial tachyarrhythmias. At last follow-up (mean 18 ± 12 months), all of the patients (n=22) were free from atrial dysrhythmias. At 3 months (n=19), 84% of patients were off antiarrhythmic drugs. By 6 months (n=18), 94% of patients were free from AF and off antiarrhythmic medications. At 12 months (n=16), 81% of patients were free from AF and off antiarrhythmic drugs and three patients remained on warfarin for a mechanical mitral valve. A full Cox-Maze procedure can be performed through a right mini-thoracotomy with outstanding short term results. This less invasive procedure can be offered to patients without compromising efficacy.