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The effects of Maze procedure combined with other cardiac surgery and its modification based on the mechanism of chronic atrial fibrillation

Maze手术联合其他心脏手术的效果及基于慢性心房颤动机制的改进

基本信息

批准号：
09470284
负责人：
KAWAZOE Kohei
金额：
$ 2.82万
依托单位：
Iwate Medical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1999
项目状态：
已结题

项目摘要

(1) Clinical results of Maze procedure for chronic atrial fibrillation combined with other cardiac surgery. The Maze procedure was safely combined with other cardiac surgery without adding undue operative morbidity and mortality. Seventy-three of 100 patients regained sinus rhythm, 21 patients were in atrial fibrillation and 6 patients underwent pacemaker implantation. Ambulatory electrocardiographic monitoring revealed that atrial fibrillatory wave in leads II or VI and left atrial diameter by echocardiography were independent predictors of sinus rhythm restoration early after the Maze procedure. The preoperative left atrial dimention may also be useful in predicting the restoration of postoperative atrial contractile function. In the follow-up period, some patients who regained sinus rhythm after procedure converted back to atrial fibrillation. The probability of sinus rhythm maintenance was 88.8 ± 3.7% at on year and 64.8 ± 7.5% at five years. It was suggested that gradual but constant attrition in the rate of sinus rhythm maintenance continued after the Maze procedure combined with mitral valve surgery.(2) Modification of the original Cox/Maze procedure We made left atriotomy line in Cox/Maze procedure into the simple isolation of four inlet orifices of pulmonary vein from left atrium. Because left atrial epicardial mapping study during operation showed that the firing potential usually located around the orifices of pulmonary vein. Although atrial tachyarrhythmia disappeared after the modification of left atrial incision, the rate of regaining sinus rhythm decreased. The further evaluation will be necessary to prove the efficacy of the modification.

(1)迷宫手术联合其他心脏手术治疗慢性房颤的临床结果。迷宫手术与其他心脏手术安全地结合在一起，没有增加不必要的手术并发症和死亡率。100例患者中73例恢复窦性心律，21例房颤，6例植入起搏器。动态心电监测显示II、VI导联房颤波和超声心动图左房内径是预测迷宫术后早期窦性心律恢复的独立指标。术前左心房内径也可作为预测术后心房收缩功能恢复的有用指标。在随访期内，部分术后恢复窦性心律的患者转为房颤。1年维持窦性心律的概率为88.8±3.7%，5年维持窦性心律的概率为64.8±7.5%。提示迷宫手术联合二尖瓣手术后，窦性心律维持率持续逐渐下降。(2)改良COX/迷宫手术，将COX/迷宫手术中的左房切开线改为四个肺静脉入口与左心房的简单隔离。由于术中左房心外膜标测显示，放电电位多位于肺静脉开口周围。左房切开改良术后房性快速性心律失常虽消失，但窦性心律复发率降低。进一步的评估将是必要的，以证明修改的效果。