The Cox maze IV procedure: Predictors of late recurrence
The Cox maze IV procedure: Predictors of late recurrence
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DOI：
10.1016/j.jtcvs.2010.08.067
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发表时间：
2011-01-01
影响因子：
6
通讯作者：
Schuessler, Richard B.
中科院分区：
文献类型：
--
作者：
Damiano, Ralph J., Jr.;Schwartz, Forrest H.;Schuessler, Richard B.
目的：COX迷宫III手术取得了较高的治愈率，成为治疗房颤的外科金标准。由于其侵袭性，一种更简单的消融辅助手术，COX迷宫IV手术，自2002年1月以来一直在我们机构进行。这项研究检查了多个术前和围手术期变量，以确定晚期复发的预测因素。方法：前瞻性收集了2002年1月至2009年12月接受COX迷宫IV手术的282名患者的数据。42%的患者有阵发性房颤，58%的患者有持续性或长期持续性房颤。所有患者均可随访。随访包括所有患者的心电图。自2006年以来，94%的患者在3个月、6个月和12个月时进行了24小时动态心电图监测。对12个月的资料进行Logistic回归分析，以13个术前和围手术期变量作为协变量。结果：66%的患者有伴随手术。在消融辅助COX迷宫手术后，3、6和12个月的房颤复发率分别为89%、93%和89%。3、6和12个月时，房颤和抗心律失常药物的缓解率分别为63%、79%和78%。左房内径增大(P=0.027)、左房后壁分离失败(P=0.022)、早期房性快速性心律失常(P=0.010)是1年后房颤复发的危险因素。结论：COX迷宫IV手术1年后的成功率很高，即使有更好的随访和更严格的失败定义。对于左心房较大的患者，可能需要更广泛的缩小或扩大病变范围。(《胸心外科杂志》2011；141：113-21)
Objectives: The Cox maze III procedure achieved high cure rates and became the surgical gold standard for the treatment of atrial fibrillation. Because of its invasiveness, a more simplified ablation-assisted procedure, the Cox maze IV procedure, has been performed at our institution since January 2002. The study examined multiple preoperative and perioperative variables to determine predictors of late recurrence.Methods: Data were collected prospectively on 282 patients who underwent the Cox maze IV procedure from January 2002 through December 2009. Forty-two percent of patients had paroxysmal and 58% had either persistent or long-standing persistent atrial fibrillation. All patients were available for follow-up. Follow-up included electrocardiograms in all patients. Since 2006, 24-hour Holter monitoring was obtained in 94% of patients at 3, 6, and 12 months. Data were analyzed by means of logistic regression analysis at 12 months, with 13 preoperative and perioperative variables used as covariates.Results: Sixty-six percent of patients had a concomitant procedure. After an ablation-assisted Cox maze procedure, the freedom from atrial fibrillation was 89%, 93%, and 89% at 3, 6, and 12 months, respectively. The freedom from both atrial fibrillation and antiarrhythmic drugs was 63%, 79%, and 78% at 3, 6, and 12 months, respectively. The risk factors for atrial fibrillation recurrence at 1 year were enlarged left atrial diameter (P = .027), failure to isolate the entire posterior left atrium (P = .022), and early atrial tachyarrhythmias (P = .010).Conclusions: The Cox maze IV procedure has a high success rate at 1 year, even with improved follow-up and stricter definitions of failure. In patients with large left atria, there might be a need for more extensive size reduction or expanded lesion sets. (J Thorac Cardiovasc Surg 2011;141:113-21)