心脏不停跳瓣膜置换同期双极射频消融对后并行循环的影响

The influence of valve replacement in the same period of bipolar radiofrequency ablation with beating heart on posterior parallel circulation

目的探讨心脏不停跳瓣膜置换同期双极射频消融对体外循环后并行循环时间的影响。方法连续性收集60例心脏瓣膜病变合并慢性房颤患者,按照患者所施行的手术方式分为两组:心脏不停跳心脏瓣膜置换同期双极射频消融组(A组,n=33),心脏不停跳心脏瓣膜置换组(B组,n=27)。比较两组患者的体外循环情况,包括心内操作时间、总体外循环时间、后并行循环时间,并于手术前后行心电图和超声心动图检查,比较左室EF变化率、转律率等,监测手术后期心功能恢复情况。结果全部患者均顺利完成手术,无严重房室传导阻滞,无围术期死亡。体外循环情况比较:A组与B组在心内操作时间上差异无统计学意义(P>0.05),而总体外循环时间和后并行循环时间A组较B组显著减少,差异有统计学意义(P<0.05)。心功能变化情况比较:两组患者术后心功能均较术前改善,但术后短期内(6个月)A组患者左室EF变化率较B组大,差异有统计学意义(P<0.05),之后心功能情况基本一致(P>0.05),趋势图显示A组患者左室变化率斜率更大,峰值更高,更快到达峰值。A组双极射频消融转律率为88%(29/33),且绝大多数(27/29)短期内(12个月)能维持窦性心律;B组27例患者有3例术后恢复窦性心律,其余24例术后12个月内仍为房颤心律,转律率只有11%。结论心脏不停跳瓣膜置换同期双极射频消融手术可以减少总体外循环时间、后并行循环时间,且安全性和转律率高、能更好地改善心功能等,具有进一步临床推广应用价值。

Objective To explore the influence of valve replacement in the same period of bipolar radiofrequency ablation with beating heart on posterior parallel circulation（ PPC）. Methods Sixty patients with valve disorders complicated with chronic atrial fibrillation were collected continuously as the research subjects and were divided into group A and group B according to different operation methods. Group A（ n = 33） received valve replacement with beating heart plus bipolar radiofrequency ablation. Group B（ n = 27） received valve replacement with beating heart alone. The variables including the intvacardiac procedure time,cardio pulmonary by pass（ CPB） time and posterior parallel circulation（ PPC） time were compared between the two groups. Electrocardiogram and echocardiogram were performed to monitor the recovery of cardiac function after the surgery,and the changes of left ventricular ejection fraction（ LVEF） and the success rate of bipolar radiofrequency ablation were compared between the two groups. Results All the patients underwent the operation successfully without atrioventricular block and were discharged from the hospital in good condition. There was no significant difference in the intvacardiac procedure time between the two groups（ P〉0. 05）. The CPB time and PPC time of group A were significantly shorter than those of group B（ P〈0. 05）. Cardiac function was improved in both of the two groups after the operation. The rate of EF change of group A was significantly higher than that of group B at postoperative 6 months（ P〈0. 05）,however there was no significant difference in cardiac function between the two groups 6 months after the operation（ P〉0. 05）. The trend graph was characterized with a faster increase and a larger peak value in group A than those in group B. The success rate of bipolar radiofrequency ablation of group A was 88%（ 29 /33）,and most of the patients（ 27 /29） could keep sinus rhythm at postoperative 12 months. The success rate of bipolar radiofrequency ablation of group B was 11%（ 3 /27）.Conclusion Valve replacement in the same period of bipolar radiofrequency ablation with beating heart is safe and effective in improvement of cardiac function with reduced CPB time and PPC time.