Zusammenfassung
In den achtziger Jahren entwarfen Professor Cox und dessen Mitarbeiter die ersten Ansätze der chirurgischen Therapie des Vorhofflimmerns durch eine Fragmentierung beider Vorhöfe mittels einer Schnittund Nahttechnik. Dieses Verfahren wurde als „MAZE procedure“ beschrieben. In Langzeitbeobachtungen von über acht Jahren konnte dieser Technik eine überaus hohe Erfolgsrate attestiert werden: in etwa 90 % der Fälle wurde ein stabiler Sinus rhythmus erreicht. Die MAZE-III-Operation von Cox beschreibt heute den „goldenen Standard“ der Therapie des Vorhofflimmerns und wird weiterhin als effektivste Methode zur Prävention von zerebralen Embolien angesehen. Aufgrund seiner Komplexität hat sich dieses Verfahren dennoch nicht in allen Zentren durchgesetzt und wird heute nur noch äußerst selten angewendet.
Nachdem Professor Haissaguerre mit modernen Mappinguntersuchungen zeigen konnte, dass Vorhofflimmern nahezu ausschließlich im linken Vorhof und dort überwiegend aus den Pulmonalvenen heraus entsteht, konzentrierten sich viele chirurgische Arbeitsgruppen vorrangig auf die linksatriale Behandlung. Die chirurgische Therapie des Vorhofflimmerns gewann in den letzten Jahren an Popularität und wird weltweit seit ca. zehn Jahren als isoliertes Verfahren oder Kombinationseingriff mit unterschiedlichen Energiequellen (uni- und bipolare Hochfrequenz-, Mikrowellen-, Ultraschallenergie und Kryoapplikation) eingesetzt.
Die Aussicht, nach der Operation einen stabilen Sinusrhythmus zu erlangen, liegt in Abhängigkeit von der Grunderkrankung zwischen 70 und 95 %. Die chirurgischen Ablationsverfahren haben sich in zahlreichen Zentren zu einer effektiven, sicheren und einfach anzuwendenden Therapie des Vorhofflimmerns entwickelt. Dies gilt sowohl für Patienten mit isoliertem Vorhofflimmern als auch insbesondere für Patienten mit zusätzlichen kardiochirurgischen Eingriffen.
Abstract
In the 1980s, Professor Cox and his co-workers put into practice the first surgical approach for the treatment of atrial fibrillation, which was performed by fragmentation of both atria with a “cut 'n sew” technique according to a particular pattern. This procedure was described as the “MAZE procedure”. The rate of success in long-term follow- up after more than eight years was approximately 90 % sinus rhythm. Today the MAZE III procedure is described as the “gold standard” in the treatment of atrial fibrillation and is proven to be the most effective method of prevention of cerebral embolism. Due to its complexity this procedure was not widely adopted in the cardiac surgical centers and is currently rarely applied.
After Professor Haissaguerre, using the modern mapping system, had shown that the left atrium, and especially the pulmonary veins, are mostly involved in the pathology of atrial fibrillation, numerous working groups focused their interest predominantly on the modes of treatment within the left atrium. Using different energy sources (unipolar and bipolar radiofrequency, microwaves, ultrasound and cryothermy) during the last ten years the surgical treatment of atrial fibrillation has gained popularity worldwide including both stand-alone and combined procedures.
The rate of stable sinus rhythm after modern operations for AF varied between 70 and 95 %. Surgical ablation of AF has evolved in numerous centers into an effective, safe and simple procedure that can be used everyday in the treatment of atrial fibrillation. It can be applied both in patients with stand-alone atrial fibrillation and in patients with concomitant indications for surgical therapy.
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Doll, N., Czesla, M., Jacobs, S. et al. Update Vorhofflimmer-Chirurgie 2008. Z Herz- Thorax- Gefäßchir 22, 23–31 (2008). https://doi.org/10.1007/s00398-008-0608-6
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DOI: https://doi.org/10.1007/s00398-008-0608-6