房颤对主动脉瓣置换术患者早期预后的影响

Impact of atrial fibrillation on early outcomes of patients undergoing aortic valve replacement

目的分析房颤对主动脉瓣置换术患者早期预后的影响。方法回顾性分析2000年1月至2011年12月在第二军医大学长海医院胸心外科接受主动脉瓣置换术(不合并其他瓣膜手术)的961例18岁以上患者的临床资料。根据术前有无房颤,将患者分为房颤组(n=54)和无房颤组(n=907),比较两组患者术前、术中情况及术后早期结果,分析房颤对早期预后的影响,并通过logistic回归分析确定患者早期死亡的危险因素。结果与无房颤组相比,房颤组患者年龄高(P<0.001)、NYHA心功能Ⅳ级比例高(P=0.039)、左室射血分数低(P=0.017)、合并肺动脉高压比例高(P<0.001)。房颤组在术后早期死亡率、呼吸机通气时间以及低心排综合征、心脏骤停或室颤、急性肾衰竭发生率等方面均高于无房颤组,差异有统计学意义(P均<0.05)。年龄、NYHA心功能Ⅳ级、房颤、体外循环时间>120min是术后早期死亡的独立危险因素。结论房颤对主动脉瓣膜置换术患者早期预后有不良影响,房颤患者的术后早期死亡率及有关并发症发生率均高于无房颤患者。

Objective To assess the impact of atrial fibrillation(AF)on the early outcomes of patients undergoing aortic valve replacement(AVR).Methods The clinical data of 961adult patients who underwent AVR in Department of Cardiothoracic Surgery,Changhai Hospital between Jan.2000and Dec.2011were retrospectively analyzed.The patients with pre-operative AF were assigned to AF group(n=54)and the rest to non-AF group(n=907).Pre-,intra-,and post-operative findings were compared to assess the impact of AF on early outcomes.Possible risk factors affecting the early mortality were identified using logistic regression analysis.Results AF patients compared with non-AF patients had an elder age(P<0.001), higher NYHA functional classification Ⅳ(P=0.039),lower left ventricular ejection fraction(P=0.017),and higher proportion of pulmonary hypertension(P<0.001).Accordingly,the post-operative early mortality,mechanical ventilation time,and incidences of low cardiac output syndrome,cardiac arrest/ventricular fibrillation,and acute renal failure were significantly higher in the AF group than those in the non-AF group(P<0.05).Logistic regression analysis showed that age, NYHA functional classification Ⅳ,AF and cardiopulmonary bypass time>120 min were independent risk factors for early mortality.Conclusion AF has a negative impact on the early outcomes of patients undergoing AVR.AF patients have higher post-operative early mortality and more related complications compared with non-AF patients.