Cox迷宫Ⅳ手术治疗心脏疾病合并心房颤动的近期疗效分析

Early Results of Cox Maze Ⅳ Procedure on Treating Artrial Fibrillation Patients Complicating With Valve Disease

目的:总结Cox迷宫Ⅳ手术治疗心脏疾病合并心房颤动的近期临床效果。方法:2017年6月至2018年9月期间,本治疗小组连续26例心脏疾病合并心房颤动患者实施心脏手术同期行Cox迷宫Ⅳ手术治疗心房颤动。手术经正中开胸,在体外循环下进行,在完成心内手术之前实施右心房及左心房的射频消融术,右心房射频在升主动脉阻断前、心脏跳动下进行,左心房射频则在心脏停跳下,经房间沟入路进行,所有患者均进行左心耳干预(包括结扎、缝扎、切除缝合及内部缝合)。结果:全组26例患者术后院内死亡1例(3.8%),出院时心房颤动复发4例(16.0%)。体外循环时间(174.4±39.5)min,主动脉阻断时间(122.7±33.3)min。术后合并哮喘1例,三尖瓣重度反流1例,反复胸腔积液1例,电复律1例。超声心动图结果显示,26例患者术后的左心房内径、左心室舒张末期内径及左心室射血分数较术前均有下降(P均<0.01)。以术后3个月作为术后首次随访时间节点,25例患者进行24小时动态心电图随访,其中4例(16.0%)心房颤动复发,其余21例(84.0%)为窦性心律,偶发房性早搏及室性早搏。结论:Cox迷宫Ⅳ手术作为外科治疗心房颤动的一种术式,心房颤动转复率高,近期疗效肯定,安全可行,值得推广。

Objectives:To summarize the early clinic efficacy of Cox Maze Ⅳ procedure in treatment of atrial fibrillation combined with valve disease.Methods:Consecutive 26 atrial fibrillation patients combined with heart valve disease were treated with Cox Maze Ⅳ procedure from June 2017 to September 2018.The surgery was performed on CPB(cardiopulmonary bypass)by median thoracotomy,the Maze procedure was performed before intracardiac surgery.The radiofrequency ablation of right atrial and left atrial was preformed before and after aortic cross clamp respectively.The left atrial appendages of all patients were disposed during the surgery(ligation,transfixion,excision or internal stitching).Results:There was 1 hospital death(3.8%).Atrial fibrillation was recurred in 4 patients(16.0%)at discharge.CPB time was(174.4±39.5)min and aortic cross clamp time was(122.7±33.3)min.Post operation,asthmatic attack occurred in 1 patient,1 patient had severe tricuspid regurgitation,1patient had repeated hydrothorax,electrical conversion was performed in 1 patient.Follow-up was made at 3 months post operation,24 h Holter was performed in 25 patients.Atrial fibrillation recurred in 4 patients(16.0%)and 21 patients were in normal sinus rhythm(84.0%)during follow up.Conclusions:Cox MazeⅣprocedure deserves to be popularized as a surgical method to treat atrial fibrillation due to its perfect recent effects and safety.