PDF(Pubmed)
Abstract：
BACKGROUND: Evaluating outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery.
METHODS: We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records.
RESULTS: There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts (n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke (p = 0.80) or permanent pacemaker (p = 0.33) between the groups.
CONCLUSIONS: Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation.
BACKGROUND: Not required.
METHODS: We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records.
RESULTS: There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts (n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke (p = 0.80) or permanent pacemaker (p = 0.33) between the groups.
CONCLUSIONS: Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation.
BACKGROUND: Not required.
摘要：
背景：评估接受高危心脏手术的老年患者并发Cox-Maze手术的结局。
方法：我们回顾性地确定了2011年至2017年年龄超过70岁的房颤（AF）患者，这些患者接受了两种或两种以上的其他心脏手术。他们分为两组：1。Cox-MazeIVAF消融。2.非手术性房颤治疗。倾向匹配评分用于生成同质队列并消除混杂变量。根据Holter报告或12导联ECG评估心律。通过电话咨询和医疗记录收集随访数据。
结果：共有239例患者。中位随访时间为61个月。70例患者进行了Cox-MazeIV手术（29.3％）。人口统计,尽管Cox-Maze组的术前房颤持续时间较短(p=0.001),但两组间的术中和术后结局相似.在倾向匹配的队列中，30天死亡率没有显著差异(n=84。P=0.078)。Maze组每年和最近一次随访的窦性心律分别为84.9%和80.0%-CoxMaze组160例患者（66.9%）在长期随访中存活，生存结果良好。在Cox-Maze组中，NYHA1状态的患者比例很高。两组之间在卒中自由（p=0.80）或永久性起搏器（p=0.33）方面没有差异。
结论：手术消融术对接受高危手术的老年患者有益-促进良好的长期无房颤和症状/预后获益。没有额外的风险。因此,手术风险不应成为否认伴随房颤消融术获益的理由.
背景：不需要。
方法：我们回顾性地确定了2011年至2017年年龄超过70岁的房颤（AF）患者，这些患者接受了两种或两种以上的其他心脏手术。他们分为两组：1。Cox-MazeIVAF消融。2.非手术性房颤治疗。倾向匹配评分用于生成同质队列并消除混杂变量。根据Holter报告或12导联ECG评估心律。通过电话咨询和医疗记录收集随访数据。
结果：共有239例患者。中位随访时间为61个月。70例患者进行了Cox-MazeIV手术（29.3％）。人口统计,尽管Cox-Maze组的术前房颤持续时间较短(p=0.001),但两组间的术中和术后结局相似.在倾向匹配的队列中，30天死亡率没有显著差异(n=84。P=0.078)。Maze组每年和最近一次随访的窦性心律分别为84.9%和80.0%-CoxMaze组160例患者（66.9%）在长期随访中存活，生存结果良好。在Cox-Maze组中，NYHA1状态的患者比例很高。两组之间在卒中自由（p=0.80）或永久性起搏器（p=0.33）方面没有差异。
结论：手术消融术对接受高危手术的老年患者有益-促进良好的长期无房颤和症状/预后获益。没有额外的风险。因此,手术风险不应成为否认伴随房颤消融术获益的理由.
背景：不需要。
