Delayed improvement in exercise capacity with restoration of sinoatrial node response in patients after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation.
Delayed improvement in exercise capacity with restoration of sinoatrial node response in patients after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation.
复制标题
器质性心脏病手术修复和心房颤动迷宫手术联合治疗后，患者运动能力延迟改善，窦房结反应恢复。
作者：
Jun Tamai;Yoshio Kosakai;Takao Yoshioka;E. Ohnishi;Hiroshi Takaki;Yoshiaki Okano;Y. Kawashima
背景
尽管迷宫手术成功地恢复了心脏病和房颤患者的窦性心律，但在心脏手术中增加迷宫手术是否有利于术后患者的运动表现仍不确定。
方法和结果
25名患者（年龄37至70岁）在瓣膜手术（18名患者）或房间隔缺损封堵术（7名患者）期间进行了迷宫手术。在术前、术后1个月、6个月和1年，使用递增方案（15 W/min）进行心肺运动试验。25例患者中有23例在术后1个月获得了鼻窦转换。然而，手术减弱了窦房结（SA）对运动的反应：静息时平均心率（HR）为83 +/- 13/min，60 W时为94 +/- 13/min，峰值运动时为107 +/- 17/min。峰值摄氧量（PVO 2）在此期间无变化（之前，17.6 +/- 4.5 mL.min-1.kg-1; 1个月后，17.5 +/- 4.2 mL.min-1.kg-1）。此后，SA结反应在术后6个月恢复：静息时平均HR为84 +/- 13/min，60 W时为104 +/- 16/min，运动峰值时为130 +/- 20/min（P <0.01 vs 1个月）。PVO 2在此期间也有所改善（20.7 +/- 4.0 mL.min-1.kg-1，P < .01）。术后1个月至6个月PVO 2的增加与HR峰值的增加相关（y = 0.73x +/- 3.6，r = 0.79）。术后6个月至1年，心率反应或PVO 2无进一步变化。
结论
采用器质性心脏病外科修补术和迷宫手术相结合的方法成功地治疗了心房颤动。然而，SA结对运动的反应在手术后早期减弱。因此，运动能力在手术后的后期得到改善，这与SA结反应的恢复程度有关。
BACKGROUND
Although the Maze procedure successfully restores sinus rhythm in patients with heart disease and atrial fibrillation, it is still uncertain whether an addition of the Maze procedure in cardiac surgery is beneficial for exercise performance of the patients after surgery.
METHODS AND RESULTS
The Maze procedure was performed in 25 patients (age, 37 to 70 years) during valve surgery (18 patients) or closure of atrial septal defect (7 patients). A cardiopulmonary exercise test using ramp incremental protocol (15 W/min) was performed before and 1 month, 6 months, and 1 year after surgery. Sinus conversion was obtained in 23 of 25 patients 1 month after surgery. However, sinoatrial (SA) node response to exercise was attenuated by surgery: Mean heart rate (HR) was 83 +/- 13/min at rest, 94 +/- 13/min at 60 W, and 107 +/- 17/min at peak exercise. Peak oxygen uptake (PVO2) was unchanged at this period (before, 17.6 +/- 4.5 mL.min-1.kg-1; 1 month after, 17.5 +/- 4.2 mL.min-1.kg-1). Thereafter, SA node response was restored 6 months after surgery: Mean HR was 84 +/- 13/min at rest, 104 +/- 16/min at 60 W, and 130 +/- 20/min at peak exercise (P < .01 versus 1 month). PVO2 was also improved at this period (20.7 +/- 4.0 mL.min-1.kg-1, P < .01). The increase in PVO2 from 1 month to 6 months after surgery was correlated with the increase in peak HR (y = 0.73x +/- 3.6, r = .79). There were no further changes in heart rate response or PVO2 from 6 months to 1 year after surgery.
CONCLUSIONS
Atrial fibrillation was successfully treated by combined treatment with surgical repair for organic heart disease and the Maze procedure. However, SA node response to exercise was attenuated early after surgery. Thus, exercise capacity was improved at the late phase after surgery, which was related to the extent of restoration in SA node response.
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DOI：
10.1016/s0022-5223(19)36684-x
发表时间：
1991-04-01
影响因子：
6
作者：
COX, JL;SCHUESSLER, RB;BOINEAU, JP
通讯作者：
BOINEAU, JP
DOI：
--
发表时间：
1991
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Cox,JL;Schuessler,RB;Boineau,JP
通讯作者：
Boineau,JP
影响因子：
4.6
作者：
COX, JL;BOINEAU, JP;CRAWFORD, FA
通讯作者：
CRAWFORD, FA
DOI：
10.1016/s0022-5223(19)36723-6
发表时间：
1991-03-01
影响因子：
6
作者：
COX, JL;CANAVAN, TE;BOINEAU, JP
通讯作者：
BOINEAU, JP