Single-Center Success of Concomitant Cryothermal Cox-Maze IV Procedure

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Surgery Pub Date : 2024-09-06 DOI:10.1155/2024/1136595
Benedikt Mayr, Anna Maria Kokott, Teodora Georgescu, Bernhard Voss, Markus Krane, Keti Vitanova
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Abstract

Background. Despite the guideline recommendation, implementation of the Cox-maze (CM) IV procedure has been variable and current data are limited. Methods. We reviewed patients with concomitant CM IV procedure (05/2019−05/2020). The primary endpoints of the study were the success rate of surgical ablation and continuity of sinus rhythm (SR) 1 year after surgery. Secondary endpoints included permanent pacemaker (PPM) implantation, postoperative mortality, and identification of predictors for postoperative SR. Results. The concomitant CM IV procedure was performed in 92 patients. Indications were persistent atrial fibrillation (AF) in 40 patients (43.5%), paroxysmal AF in 36 (39.1%), and long-standing persistent AF in 16 (17.4%). At hospital discharge, SR was achieved in 49 patients (63.6%) and PPM implantation was necessary in 12 patients (13%). At 1 year after surgical ablation, SR was seen in 31 patients (59.6%) and PPM implantation was required in six further patients (6.5%). Patients with long-standing persistent AF were significantly less likely to achieve SR (odds ratio (OR): 0.18, p = 0.003), and postoperative mortality was significantly increased in this subgroup (hazard ratio (HR): 5.4, p = 0.02). In patients with enlarged left atrial (LA) diameter, the probability of achieving SR was significantly decreased (OR: 0.48, p = 0.045). Need for postoperative dialysis (HR: 12.9, p = 0.02) and prolonged stay in the intensive care unit (HR: 2.2, p = 0.01) were independently associated with increased mortality after CM IV. Conclusions. The cryothermal CM IV procedure has an overall 1-year success rate of 60% with increased rates of PPM implantation. Patients with long-standing persistent AF and increased LA diameter were significantly less likely to achieve SR.

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单中心成功实施低温 Cox-Maze IV 程序
背景。尽管有指南建议,Cox-maze(CM)IV 程序的实施情况却不尽相同,目前的数据也很有限。方法。我们回顾了同时进行CM IV手术的患者(2019年5月至2020年5月)。研究的主要终点是手术消融的成功率和术后一年窦性心律(SR)的持续性。次要终点包括永久起搏器(PPM)植入、术后死亡率以及术后窦性心律预测因素的鉴定。结果。92名患者同时进行了CM IV手术。40名患者(43.5%)的适应症为持续性房颤(AF),36名患者(39.1%)为阵发性房颤,16名患者(17.4%)为长期持续性房颤。出院时,49 名患者(63.6%)达到了 SR,12 名患者(13%)需要植入 PPM。手术消融 1 年后,31 名患者(59.6%)达到了 SR,另有 6 名患者(6.5%)需要植入 PPM。长期持续性房颤患者获得 SR 的几率明显较低(几率比 (OR):0.18,P = 0.003),而且该亚组患者的术后死亡率明显增加(危险比 (HR):5.4,P = 0.02)。在左心房(LA)直径增大的患者中,达到 SR 的概率明显降低(OR:0.48,p = 0.045)。术后需要透析(HR:12.9,p = 0.02)和在重症监护室住院时间延长(HR:2.2,p = 0.01)与 CM IV 后死亡率增加有独立关联。结论低温 CM IV 手术的 1 年总体成功率为 60%,PPM 植入率有所提高。长期持续房颤和 LA 直径增大的患者获得 SR 的可能性明显降低。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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