Marcelo B JateneI; Eduardo SosaII; Fábio B JateneI; Flávio TarasoutchiII; Ana Cristina MonteiroII; Pedro R SalernoIII; Luiz Carlos Bento de SouzaIII; José Carlos PachónIII; Adib D JateneI
DOI: 10.1590/S0102-76381995000100003
RESUMO
A operação de Cox para fibrilação atrial (FA), descrita inicialmente para os casos de FA crônica e ou paroxística, vem tendo, em nosso meio, emprego freqüente em pacientes (pts) valvopatas mitrais portadores de FA, com controle da arritmia a médio e longo prazo. Entre julho 91 e outubro 94, 32 pts (25 femininos) portadores de FA crônica e valvopatia mitral foram operados. A idade média foi de 50,2 anos (35 a 68), sendo a valvopatia de origem reumática em 30 pts e mixomatosa em 2; 81,2% dos pacientes encontravam-se em CF IV (NYHA), sendo que 9 haviam sido previamente operados e 4 tiveram episódio prévio de embolia sistêmica. O diâmetro médio do AE era de 5,5 cm e a PSAP de 55 mmHg. Todos os pts foram operados por esternotomia mediana, seguindo a técnica original descrita por Cox (Cox I) em 18 pts e a técnica modificada (Cox 111) em 14 pts. Crioablação dos anéis mitral, tricúspide e seio coronário foi utilizada em 25 pts. Em 17 pts a valva mitral foi substituída por bioprótese de PB e conservada em 15 pts. Foram observados 2 óbitos hospitalares (baixo débito e insuficiência hepática); 14 pts fizeram uso de MP temporário no pósoperatório imediato e 4 apresentaram insuficiência respiratória com boa evolução. Um paciente apresentou morte súbita domiciliar, uma semana após a alta. Em 25 pts com evolução superior a 6 meses (média 25 m), 24 encontram-se em ritmo regular (sinusal em 19 e juncional em 5), assintomáticos e com FC média de 71,5 bpm. Contração atrial foi demonstrada pelo ECO, sendo menos efetiva no AE. Um paciente foi submetido a implante de MP definitivo por bradicardia sinusal no 2 mês de PO. Em conclusão, a operação de Cox vem mostrando resultados reprodutíveis na FA associada à doença mitral, com obtenção de ritmo regular e contração atrial presente. Não houve recorrência de FA no período avaliado.ABSTRACT
The "Maze" procedure for surgical treatment of chronic atrial fibrillation (AF) described by Cox was performed in 34 patients (pts) from July 91 to October 94; 26 were female and the ages ranged from 35 to 68y (50.2y). All pts had mitral valve disease (MVD) and chronic AF (> 1 year). Thirty one pts had surgical rheumatic MVD (mitral stenosis in 21; mitral double disfunction in 9) and 3 had mixomatous MVD with severe regurgitation. Twenty eight pts were in FC (NYHA) IV and 6 in FC III preoperatively. Left atrium diameter varied from 4.4 to 6.5 cm (5.5 cm). In 21 pts the surgical treatment was performed following the original "Maze" technique and in 13 pts with the modifications proposed by Cox. The surgery was completed with 17 mitral conservative procedures and 17 mitral valve replacements (bovine pericardium bioprostheses). Eight pts had left atrial thrombosis. There were 2 (5.8%) immediate deaths (low cardiac output and severe liver disfunction) and 1 patient died in the 48th day with infeccious complications. The first patient required reoperation for bleeding review. Atrial arrhythmias were observed in 6 pts and 14 required temporary pace-maker. Regular "sinus" rhythm was observed in all pts. No other major complications were observed. In 30 pts with more than 6 months of follow up, 27 (90%) were in regular rhythm (heart rate from 55 to 87bpm), with no antiarrhythmic drugs and atrial contraction demonstrated by ECHO. In conclusion, the "Maze" procedure showed effective to treat AF even in pts with big atrium and MVD, with acceptable immediate and late results. Longer observation is required to a definitive conclusion.REFERÊNCIAS
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