部分自体心脏移植术治疗巨大左心房患者手术效果分析

Efficacy of Partial Cardiac Auto-transplantation for Treating the Patients With Giant Left Atrium

目的:本研究旨在探讨部分自体心脏移植术治疗巨大左心房患者手术效果及早期生存率。方法:自2012-08到2013-05间在我院接受风湿性心脏病部分自体心脏移植术患者7例,均伴有巨大左心房,且术前均伴有心房颤动(房颤),男性3例,平均年龄(54.9±5.0)岁,对其中6例患者实施房颤射频消融术。监测7例患者术前基本情况、术中情况及围术期死亡率、并发症发生率,并进行分析。结果:7例患者行二尖瓣置换术,其中5例患者行主动脉瓣置换术,2例行主动脉瓣成形术,主动脉阻断时间为(271.7±29.0)min。7例患者术后左心房直径均值从(91.7±3.5)mm降至(64.8±8.1)mm(P<0.05),出院前左心室射血分数(LVEF)从(38.3±6.5)%上升至(47.4±6.1)%(P均<0.05),4例患者恢复窦性心律。围术期无患者死亡,随访(20.7±3.9)个月,术后1年生存率为100%,1例患者术后17个月死亡,6例存活患者最后一次随访左心房直径平均值为(56.3±3.4)mm。结论:对部分巨大左心房患者实施部分自体心脏移植术可明显减小左心房直径,可获得良好的临床效果。

Objective： To explore the clinical efficacy and short-term survival rate of partial cardiac auto-transplantation for treating the patients with giant left atrium.Methods： A total of 7 patients with rheumatic heart disease received partial cardiac auto-transplantation in our hospital from 2012-08 to 2013-05 were retrospectively studied. The patients were at the age of（54.9±5.0） years including 3 male, all of them combined with giant left atrium and pre-operative atrial fibrillation（AF）, 6 of them received radio-frequency ablation. All patients were monitored for their baseline condition, operative status, peri-operative mortality and complication occurrence for clinical analysis. Results： All 7 patients received mitral valve replacement, 5 had aortic valve replacement and 2 had aortic valve-plasty, the mean aortic cross clamp time was（271.7±29.0） min. The average left atrial diameter decreased from（91.7±3.5） mm to（64.8±8.1） mm, left ventricular ejection fraction（LVEF） improved from（38.3±6.5） % to（47.4±6.1） % at discharge, all P〈0.05; 4 patients recovered to sinus rhythm and no peri-operative death occurred. The patients were followedup for（20.7±3.9） months, 1 year post-operational survival rate was 100%, 1 patient died at 17 months after operation and the average left atrial diameter was（56.3±3.4） mm in rest 6 patients at the last examination during follow-up period.Conclusion： Partial cardiac auto-transplantation may obviously reduce left atrial diameter with good clinical effect in certain patients with giant left atrium.