上大静脈へのラインを省略したmaze手術の遠隔成績

Long-term Outcomes of the Maze Procedure Omitting the Ablation Line to The Superior Vena Cava

1991年にCoxらにより報告1，2）されたオリジナルmaze手術は，ほとんどの隔離線を切開と縫合で行われるため，手術時間がかかり出血が危惧された．Kosakaiらによる冷凍凝固を多用した術式の報告や3），外科的アブレーションデバイスの登場によるCox-maze Ⅳの報告を経て4），現在では各施設でさまざまなlesion setが用いられている5）．

Objective：In an effort to avoid postoperative sick sinus syndrome （SSS）, we omit the ablation line to the superior vena cava （SVC） in the Cox-mazeⅢ lesion set. We report the long-term outcomes, including the freedom from SSS.

Methods：We studied 102 patients who underwent bi-atrial maze procedure for persistent atrial fibrillation （Af） from 2009 through 2023. Bipolar radio frequency ablation or cryoablation was used except for right-side atriotomy and right atriotomy. Cryoablation was used for atrioventricular annulus. The patient age was 68±9.4. Duration of Af was 3.4±6.5 years （unknown 9 cases）. The amplitude of f-wave in V1 was 0.182±0.095 mV and it was＜0.1 mV in 19 （18.6％）. Diameter of the left atrium was 50±8.9 mm, and left atrial volume index was 89±37 ml/m2. Ninety-one （89.2％） patients underwent concomitant mitral valve surgery.

Results：Survival rate was 99％ at 1 year and 96％ at 5 years. Freedom from Af was 92％ at 1 year and 88％ at 5 years. Freedom from permanent pacemaker implantation （PPI） was 87％ at 1 year and 83％ at 5 years.

Conclusions：Defibrillation rate and the incidence of PPI was comparable to those in previous reports after standard Cox-mazeⅢ. SSS after maze for persistent Af seem due to patient.