换瓣同期行心内微波消融治疗风湿性二尖瓣病变伴心房颤动——近中期疗效分析

Intraoperative microwave ablation for sustained atrial fibrillation in rheumatic patients undergoing mitral valvular replacement:early and midterm results

目的:探讨风湿性二尖瓣病变伴心房颤动(房颤)病例换瓣同期行心内微波消融术的近、中期疗效及可行性。方法:回顾性分析58例换瓣同期行心内微波消融术的风湿性二尖瓣病变伴房颤病例,患者平均年龄(49±12)岁;临床均确诊为风湿性二尖瓣疾病合并房颤,房颤病史平均(4.2±2.9)年。所有患者随访时间为术后3个月,6个月及12个月。结果:58例心脏手术复跳后均为窦性心律(100%),微波消融时间平均(15±5.2)min。围手术期因重度低心排出量综合征和呼吸衰竭死亡各1例。出院时51例患者为窦性心律,近期转复率为91.1%。术后6个月,2例复发转为房颤,49例为窦性心律(87.5%),术后12个月49例仍为窦性心率,总有效率87.5%。术后无血栓形成及神经系统并发症。结论:在风湿性二尖瓣病变伴房颤的病例换瓣同期行心内微波消融治疗是一种安全、有效的方法,且操作较“迷宫手术”和射频消融简单,手术时间短,易于推广。

Objective： To assess the efficacy and feasibility of intraoperative microwave ablation to restore sinus rhythm in rheumatic patients undergoing mitral valvalar replacement. Method：Fifty-eight patients with sustained atrial fibrillation （AF） underwent operations, The mean age was（49 ：：l： 12） years （range,5-68 years）. The mean duration time of AF was 4.2 ~ 2.9 years. All patients were Rheumatic Heart Disease, and underwent mitral valve replacement. The microwave procedure （ FLEX, AFx inc. ） was performed to create an endocardial bilateral encircling isolation of the ostia of the pulmonary veins. Follow-up time points were at 3, 6 and 12 month after surgery. Result：All patients （100%） were successfully converted to sinus rhythrm after restoring beating,The mean time of the procedure was （15 ± 5.2） minutes, There were 2 postoperative deaths for cardic output low and failure of respiration ,51 patients were sinus rehythm at discharge [ （51/56 （91.1% ）],At 6-month, 2 patients were AF, at 12 months 49 patients still maintained sinus rhythm （49/56 87.5 % ）, Total efficacy rate was 87.5 %. There were no complications of thrombosis and embolism.Conclusion：Intraoperative microwave ablation is a safe and effective treatment to restore sinus rhythm in patients with rheumatic mitral valvular disease and AF.