Journal of Chest Surgery

  • 제41권6호
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  • Pages.710-717
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  • 2008
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

냉동 절제를 이용한 변형된 Maze술 식의 중장기 결과

The Long-term Results of a Modified Maze Procedure with Using Cryoablation

  • 박권재 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 우종수 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 방정희 (동아대학교 의과대학 동아대학교병원 흉부외과학교실)
  • Park, Kwon-Jae (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Woo, Jong-Soo (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Bang, Jung-Hee (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine)
  • 발행 : 2008.12.05
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⟨ 이전 논문 다음 논문 ⟩

초록

배경: 심방 세동은 뇌혈관 사고, 말초 동맥 색전증 같은 합병증과 많은 연관이 되어 있고 무엇보다도 만성적으로 이 부정맥을 가지고 있는 환자들은 가슴 두근거림과 깜짝 놀램 증상 등이 있어서 환자의 삶의 질을 많이 떨어뜨린다. 이 논문의 목적은 본 교실에서 시행해 온 변형된 Maze술 식의 중장기 결과를 내고 이에 영향을 주는 요인들을 조사하는데 있다. 대상 및 방법: 2001년 6월부터 2007년 2월까지 88명을 대상으로 조사를 하였고 모두 본 교실에서 냉동절제(cryoabation)을 이용한 변형된 Maze술 식을 받았다. 냉동절제로 폐정맥 부분을 분리하는 방법에 따라 두 그룹으로 나누었고, 첫 번째 그룹은 58명(group 1, Lee-Maze, n=58)으로 우측 폐정맥은 절개 및 봉합으로 좌측 폐정맥은 냉동절제로 분리하였고, 두 번째 그룹은 30명(group 2, Cryo-Maze, n=30)으로 좌측 및 우측 폐정맥 부분 모두를 냉동 절제로만 시행하였다. 술 후 퇴원 시 동율동 전환 여부와 추적 관찰에서의 동율동 유지 및 심방 세동의 재발, 그리고 마지막 추적 관찰시의 심장리듬을 알아보았다. 결과: 모든 환자의 추적 관찰 기간은 평균 $44.3{\pm}19.2$개월이었고, 퇴윈 시 리듬은 group 1 (Lee-Maze)에서는 동율동이 72.4%에서 나타났고 group 2 (Cryo-Maze)에서는 66.7%가 관찰되었다. 마지막 추적 관찰 시 리듬은 group 1에서 81%, group 2에서는 60%에서 심방 세동이 재발하지 않았다. 그리고 Kaplan-Meier방법으로 분석을 해 보았을 때 심방 세동 재발로부터의 자유률(% Free from AF)은 group 1에서 1년 86.5%, 5년 80%였고, group 2에서는 1년 70%, 5년 51%였다. 결론: 냉동 절제를 이용한 변형된 Maze술은 단순하고 효과적인 수술이지만, 표준적 MazeIII 술 보다는 다소 낮은 성공률을 보이고 있다. 냉동 절제를 이용한 변형된 방법은 수술 시간이 단축될 수 있으나 성공률을 높이기 위해서는 더욱 많은 연구와 노력이 필요할 것으로 사료된다.

Background: Atrial fibrillation is associated with several complications such as cerebro-vascular accidents and peripheral arterial embolism. Most of the patients who have this arrhythmia chronically feel their heart beating and so they are frightened; therefore, the quality of a patient's life is decreased. The purpose of this article is to determine the long term results of a modified Maze procedure and the factors that influence the success of the procedure. Material and Method: This study enrolled 88 patients who underwent the modified Maze with using cryoablation between June, 2001 and February, 2007. The 88 consecutive patients were divided into two groups ac cording to how the pulmonary veins were isolated, that is, with or without cryoablation. There were 58 patients who were isolated by cutting and sewing in the right pulmonary veins and by cyroablation in the left pulmonary veins in group 1 (group 1, n=58), and 30 patients who underwent isolation by cryoablation in the right & left pulmonary veins were placed in group 2 (group 2, n=30). The ECG was checked at discharge to determine the sinus conversion rate and we followed up the patients to determine whether or not the patients maintained sinus rhythm. We also checked the ECG at the last visit to determine the patients' heart rhythm. Result: The mean follow up time was $44.3{\pm}19.2$ months. At discharge, 72.4% of the patients in group 1 were in proper sinus rhythm and 66.7% of the patients in group 2 were in proper sinus rhythm. At the last follow up, 81% of the patients in group 1 were in normal sinus rhythm and 60% of the patients in group 2 were in normal sinus rhythm. When we analyzed the data via the Kaplan-Meier method, 86.5% of the patients were free from atrial fibrillation (% free from AF) at 1 year, 80% of the patients were free from atrial fibrillation at 5 year in group 1 and 70% of the patients were free from atrial fibrillation at 1 year and 51 % of the patients in group 2 were free from atrial fibrillation at 5 year. Conclusion: The modified Maze technique using cryoablation was a simple and effective procedure. But the success rate of the Maze technique using cryoblation is lower than that of the standard Maze III. The method using cryoablation shorten the operation time, but we must conduct more studies to get a better result of the modified Maze technique with using cryoablation.

키워드

참고문헌

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