56例微创外科治疗单纯性心房颤动的临床经验

Experience of 56 cases minimally invasive surgical treatment of atrial fibrillation

目的:总结56例微创外科手术治疗单纯性心房颤动(房颤)的临床经验。探讨该术式的安全性、高效性及微创外科治疗房颤的特点和优势。方法:自2006年12月至2007年9月,对56例单纯性房颤患者施行了胸腔镜辅助下心表双侧肺静脉隔离术。本组病例包括抗心律失常药物治疗无效或不能耐受药物及导管消融术后复发患者。手术切口包括每侧胸壁各2个1cm腔镜及器械入口,1个5cm手术操作切口。主要方法有双侧肺静脉分离和肺静脉与左心房间的射频消融隔离及左心耳切除。术中使用了WOLF分离器和ATRICURE双极射频消融夹,EZ45G软组织切割缝合器。结果:手术过程顺利,消融术后应用多导生理仪测试证明肺静脉电隔离完全。除14例术后在手术室行电复律外,其他病例术后均为窦性心律。手术时间(150±23)min,平均术中失血量80mL,无手术死亡。除2例患者因术后低血氧症再次气管插管和因术后急性左心功能不全行主动脉内球囊反搏(IABP)辅助外,其余患者术后无严重并发症。术后平均住院天数(7.5±2.3)d。术后随访至6个月,无死亡及中风发生。术后窦性心律转复率:3个月81.3%;6个月90%。结论:本组手术证明微创外科手术治疗心房颤动具有经济、简单、创伤小、肺静脉隔离确切、安全性及有效性高等特点,应予以推广。

Objective： This study is to introduce our experience from 56 cases minimally invasive surgical treatment of atrial fibrillation; to evaluate the safety and the high effectivity of this new surgical treatment technique ; to discuss its advantages. Method： From December 2006 to September 2007, 56 patients with atrial fibrillation accepted video assisted thoracoscopic off-pump epicardial pulmonary vein isolation. All patients had had unsuccessful drug therapy or were intolerant to antiarrhythmic drug therapy or had had unsuccessful catheter-based ablation. The procedure includes 2 1 cm ports for the thoracoscopic camera and ablation device, and a 5 cm working port on each side of the chest wall. Pulmonary vine isolation was achieved bilaterally by using an ATRICURETM bipolar radiofrequency device. LAA was existed by using a Johnson ＆ Johnson EZ45G stapler. Result： The procedure was performed successfully in all patients. None of the cases needed to convert to sternotomy. Intraoperative pacing and sensing was used to confirm bidirectional block of the ablation lines. Except of 14 cases that needed electrical conversion of AF in the OR, all other cases were in sinus rhythm immediately after the surgery. There were no complications other than postoperative fever for all cases except 1 case was reintuhated because of low SaO2 , and 1 ease used IABP for LV failure. Average hospital stay is （7.5 ± 2, 3） days. All patients have been followed up for up to 6 months： 26 out of 32 eases who had been followed for 3 month were free of AF 81.3% （26/32）, there were 10 cases had been followed for 6 months and 9 of them were in sinus rhythm 90% （9/10）. Conclusion： Our experience from this group proofed that the minimally invasive surgery is safe and elective. Compare with catheter based ablation and surgical treatment of AF through sternotomy, this video assisted thoracoscopic pulmonary vine isolation is simple, less expensive, less invasive and reliable on transmurality, and is a promising procedure in AF treatment.