左心耳温存maze手術の遠隔成績

The Long Outcome of the Left Atrial Appendage Preserving Maze Procedure

Maze手術によって期待されることは，心原性塞栓症の予防だけではなく心房機能の回復，すなわち心房booster functionによる心拍出量の増加もある．左房機能の回復のうえで左心耳の貢献度が大きいことから，左心耳に血栓がない限り温存してきた．しかしながら，心原性脳梗塞の血栓発生部位の90％は左心耳であるとの報告1）もあることから，われわれは左心耳温存が長期遠隔成績，特に脳梗塞併発に影響するか検討した．

We retrospectively study the outcome of left atrial appendage （LAA） preserving maze procedure, focus on thrombus formation in left atrium （LA）, postoperative stroke, and LA function.

Patients and methods：We studied 131 patients （mean age, 68.2y；77 men and 54 women） who underwent maze procedure for atrial fibrillation （Af） between 2008 and 2020. Full maze was performed for 116 patients with long-standing persistent Af or persistent Af. Pulmonary vein isolation alone was performed for 15 patients with paroxysmal Af. The mean follow-up period was 2.9 （10.1-0.4） years.

Results：In perioperative results, there were no death, cerebral infarction, and reoperation in this series. At discharge, 1 year, 3 years, 5 years, and 10 years after the surgery, sinus rhythm was maintained in 92％, 87％, 83％, 77％. Pacemaker was implanted in 8 （early 3, late 5） patients. Despite adequate anticoagulant therapy, one patient developed cerebral infarction a month postoperatively. In other patients, there was no cerebral infarction in short-term nor long-term.

Conclusions：The LAA preserving maze procedure was not a risk factor of cerebral infarction under appropriate medication. However, close follow-up is essential.