The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades.
The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades.
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DOI：
10.1161/circep.111.963819
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发表时间：
2012-02
期刊：
影响因子：
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通讯作者：
Damiano RJ Jr
中科院分区：
文献类型：
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作者：
Weimar T;Schena S;Bailey MS;Maniar HS;Schuessler RB;Cox JL;Damiano RJ Jr
Cox-Maze 手术 (CMP) 在治疗心房颤动 (AF) 方面取得了很高的成功率，同时其侵入性也逐渐降低。本报告评估了我们二十年来使用 CMP 治疗孤立性 AF 的经验，并将原始的裁剪和缝合 CMP-III 与消融辅助 CMP-IV 进行了比较，后者使用双极射频和冷冻能量来创建原始病变模式。前瞻性收集了 212 名连续患者（平均年龄：53.5±10.4，78% 男性）的数据，这些患者从 1992 年到 2010 年接受了独立 CMP。术前 AF 的中位持续时间为 6 (IQR 2.9–11.5) 年，其中 48% 为阵发性，52% 为持续性或长期持续性 AF。使用术前和围手术期变量作为 CMP-III (n=112) 和 CMP-IV (n=100) 的协变量进行单变量分析。总体而言，30 天死亡率为 1.4%，无术中死亡。平均随访时间为 3.6 ± 3.1 年，摆脱 AF 的率为 93%，脱离抗心律失常药物后摆脱 AF 的率为 82%。 10 年后无症状性房颤的率为 85%。仅发生 1 例晚期卒中，80% 的患者停止抗凝治疗。侵入性较小的 CMP-IV 的交叉钳夹时间显着缩短（41±13 分钟与 92±26 分钟，p<0.001），同时实现了较高的成功率，2 年时 90% 的房颤消失率和 84% 的房颤摆脱抗心律失常药物。 CMP 虽然通过替代能源进行了简化和缩短，但即使改进了后续工作并更严格地定义了失败，也能取得优异的结果。
The Cox-Maze procedure (CMP) has achieved high success rates in the therapy of atrial fibrillation (AF) while becoming progressively less invasive. This report evaluates our experience with the CMP in the treatment of lone AF over two decades and compares the original cut-and-sew CMP-III to the ablation-assisted CMP-IV, which uses bipolar radiofrequency and cryoenergy to create the original lesion pattern. Data were collected prospectively on 212 consecutive patients (mean age: 53.5±10.4, 78% males), who underwent a stand-alone CMP from 1992 through 2010. Median duration of preoperative AF was 6 (IQR 2.9–11.5) years, with 48% paroxysmal and 52% persistent or longstanding persistent AF. Univariate analysis with preoperative and perioperative variables used as covariates for the CMP-III (n=112) and the CMP-IV (n=100) was performed. Overall, 30-day mortality was 1.4% with no intraoperative deaths. Freedom from AF was 93% and freedom from AF off antiarrhythmics was 82% at a mean follow-up time of 3.6 ± 3.1 years. Freedom from symptomatic AF at 10 years was 85%. Only one late stroke occurred with 80% of patients being off anticoagulation. The less invasive CMP-IV had significantly shorter cross-clamp times (41±13 vs. 92±26 minutes, p<0.001) while achieving high success rates with 90% freedom from AF and 84% freedom from AF off antiarrhythmics at 2 years. The CMP, while simplified and shortened by alternative energy sources, has excellent results even with improved follow-up and stricter definition of failure.