术前房颤对左房室瓣置换术术后早期疗效的影响

Impact of preoperative atrial fibrillation on early outcome of mitral valve replacement

目的明确术前房颤对左房室瓣置换术后早期疗效的影响。方法收集1998年1月至2008年12月在我院行单纯左房室瓣置换术或联合右房室瓣成形术的左房室瓣病变患者资料,共2 001例,筛选出1 411例纳入研究,按照术前是否发生房颤分为两组:(1)窦性心律(SR)组,639例;(2)房颤(AF)组,772例。应用SPSS 18.0软件进行统计学处理,AF、SR两组计量资料比较采用t检验,术后早期病死率以及早期并发症发生率的比较用χ2检验。结果AF组左房室瓣置换术后早期病死率高于SR组(5.1%vs 2.8%,P=0.041),心血管并发症发生率高于SR组(9.5%vs 4.4%,P<0.001),其中低心排综合征及心室纤颤的发生率在AF组明显增高(4.0%vs 2.0%,P=0.044;2.7%vs 1.1%,P=0.034)。瓣膜相关并发症、全身系统并发症发生率及二次手术率在两组间差异无统计学意义。多因素分析显示术前房颤并不是预测左房室瓣置换术后早期死亡的独立危险因素。结论术前伴有房颤可增加术后早期病死率,房颤发生是左房室瓣病变加重的重要标志之一。

Objective To study the influence of preoperative atrial fibrillation（AF） on early outcome after mitral valve replacement（MVR）.Methods Between January 1998 and December 2008,a total of 2,001 patients underwent MVR with or without tricuspid valve repair in our hospital,and 1,411 patients were included in the present study.The selected patients were divided into two groups according to preoperative rhythm status： AF group（n=772） and sinus rhythm（SR） group（n=639）.The clinical data of AF group and SR group were compared using t test;the early mortality and incidences of complications of MVR were compared with χ2 test between the two groups.Results The early mortality of MVR in AF group was significantly higher than that in the SR group（5.1% vs 2.8%,P=0.041）.Incidence of cardiovascular complications was also significantly different between the two groups（AF group 9.5% vs SR group 4.9%,P0.001）.Specially,the incidences of low cardiac output syndrome and ventricular fibrillation were significantly higher in AF group than in SR group（4.0% vs 2.0%,P=0.044;2.7% vs 1.1%,P=0.034）.There were no significant differences in the incidences of prosthetic-valve complications,systemic complications and reoperation rates between the two groups.Multivariate analysis shows that preoperative AF is not an independent predictor for early death.Conclusion Early mortality of MVR is higher in AF group.The onset of preoperative AF is a marker of aggravated mitral valve disease.