心脏手术同期心外膜永久起搏器植入术临床应用观察

Clinical application of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery

目的总结心脏手术同期行心外膜永久起搏器植入术的疗效及临床应用经验。方法2014年11月至2016年7月在解放军总医院心血管外科住院治疗的符合心脏起搏器植入指征，需要心脏手术的心动过缓患者15例行心脏手术同期心外膜永久起搏器植入术，男9例，女6例，年龄50～73（63.5±6.2）岁。手术均在全麻下进行，胸部正中切口入路。其中，单腔起搏器手术10例，双腔起搏器手术5例；同期瓣膜置换术7例，瓣膜置换加房颤射频消融术3例，冠状动脉旁路移植术2例，主动脉根部置换术2例，瓣膜置换联合冠状动脉旁路移植术1例。术中、术后1周及6个月随访检测起搏参数变化。结果15例患者在心脏手术同期植入心外膜永久起搏器，均顺利治愈出院，无手术并发症。共植入20根心外膜电极，其中右心房电极5根，右心室电极15根。术后随访3～22个月，中位随访12个月，无电极断裂及手术伤口感染发生，起搏阈值、感知参数及电极阻抗均正常。结论对于需要心脏手术的心动过缓患者在心脏手术同期行心外膜永久起搏器植入术安全有效，近中期结果满意，避免了分期手术风险。

ObjectiveTo summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. MethodsFrom November 2014 to July 2016, 15 patients （9 males and 6 females） with ages ranging from 50 to 73 （63.5±6.2） years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker （n=10） and dual chamber pacemaker （n=5） permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery.ResultsAll 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up.ConclusionsFor patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.