| Background:Atrial fibrillation is one of the most common clinical arrhythmia.Rapid and disorderly atrial fibrillation waves replace the regular and orderly atrial electrical activity,which decrease the cardiac mechanical function and cause hemodynamic changes.And it could be found in almost all heart disease and cause serious complications,so it is a serious threaten to people's health.The rate of elderly patients with atrial fibrillation and other diseases is higher,and the type of atrial fibrillation is mainly long-standing persistent.Atrial fibrillation is the key difficulty in clinical for elderly.Cox-maze ? and IV procedure are the main surgical interventions for treating atrial fibrillation.What's more,the Cox-maze ? procedure is considered as the "gold standard" for the treatment of atrial fibrillation because of its good efficacy.Although the maze procedure has a satisfactory efficacy,few heart centers could conduct the Cox-maze ? procedure for the patients with atrial fibrillation in the world.The main concern is the safety of the maze procedure.As elderly patients have the decreased organ function,the surgical tolerance is declined,so the more difficult and dangerous maze procedure is a greater challenge for elderly patients complicated by atrial fibrillation.In addition,the aging increase the rate of atrial fibrillation and affect the postoperative efficacy of maze procedure.The safety and efficacy of Cox-maze ? procedure in elderly patients with atrial fibrillation remain to be studied.With the aging of the population,the number of elderly patients with atrial fibrillation is increasing,while there were few relevant studies.We conducted a retrospective study to evaluate the safety and efficacy of Cox-Maze ? procedure in elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation.We hope that this study can provide a reference for clinicaltreatment of elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation.Objective:To evaluate the safety and efficacy of the Cox-Maze ? procedure in elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation.Methods:In the past five years of our hospital,a total of 166 patients were included in the study,in which the “cut-and-sew” Cox-Maze ? procedure were conducted.According to the WHO's definition of the elderly people,they are divided into the elder group(?60 years,n=70)and the younger group(< 60 years,n=96)to compare the differences of intraoperative safety indexes?postoperative safety indexes?early mortality and efficacy between the two groups.Results:(1)Intraoperative safety indexes: the elderly group had higher rates of the coronary artery bypass grafting and the use of biological valve(P <0.05),other indexes were no significant differences(P>0.05).(2)Postoperative safety indexes:although the elderly patients had longer time of ventilator use(P <0.05),but the the ICU stay time and postoperative hospitalization days were not increased(P>0.05).The incidence of adverse events such as the secondary-thoracotomy bleeding?low cardiac output syndrome?stroke?reintubation?intra-aortic balloon pump implantation?temporary pacemaker application and early mortality were no significant differences between the two groups(P > 0.05),the risk of surgery was not increased for elderly patients(P > 0.05).(3)Postoperative efficacy: at discharge,both groups were all at NYHA function class I or II;the rates to achieve sinus rhythm at discharge and postoperative follow-up at 6months and 1 year were all above 85%,the overall efficacy was satisfactory,and the efficacy did not decrease for elderly patients(P>0.05).Conclusion:Cox-Maze ? procedure was safety for elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation,and the short-term efficacy was satisfactory. |
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