终末期心房颤动的外科瓣膜手术疗效评价

Efficacy of surgical valve surgery for end stage atrial fibrillation:a report of 693 cases

目的分析终末期心房颤动患者的临床及超声诊断要点,总结其中采用外科瓣膜手术干预的患者术后中远期疗效。方法回顾性分析2012年1月至2019年6月北部战区总医院心血管外科693例心脏超声诊断为“心房颤动”患者,根据房室瓣反流的不同情况,分为4组,A组为二尖瓣和/或三尖瓣微量或轻度关闭不全,B组仅以三尖瓣中度及以上关闭不全,C组仅以二尖瓣中度及以上关闭不全,D组为二尖瓣及三尖瓣均有中度及以上关闭不全。后3组患者共计505例,其中124例患者进行了心脏瓣膜手术治疗。结果693例患者房室瓣反流的程度不断变化,有65例患者经内科治疗后反流程度减轻,其中23例进行了内科房颤射频消融术;505例患者房室瓣反流加重。房室瓣反流程度较重患者中未手术组的房颤病史明显长于手术组,左室内径明显大于手术组,左室收缩和舒张功能也低于手术组(P<0.05);124例外科手术患者中围术期死亡1例,余随访6~94个月,平均随访时间为63.03(54.61~71.44)个月。配对分析发现术后各房室内径均明显减小(P<0.001),心功能分级明显改善(P<0.001),焦虑自评量表(Self-rating Anxiety Scale,SAS)评分明显下降(P<0.001);尽管部分患者(24例)术后出现LVEF降低,但差异尚无统计学意义(P=0.067)。16例瓣膜手术同时行迷宫术,87.5%(14/16)恢复并维持窦性心律;单纯行瓣膜手术107例,16.8%(18/107)可恢复并维持窦性心律。结论房室瓣大量反流的终末期房颤患者应积极行外科瓣膜手术治疗,手术风险小且可获得良好的生活质量。

Objective To summarize the mid-and long-term curative efficacy of surgical valve surgery intervention for the patients with end-stage atrial fibrillation by analyzing the main points of clinical and ultrasonic diagnosis.Methods Clinical data of 693 patients with atrial fibrillation diagnosed by echocardiography admitted to our General Hospital of Northern Theater Command from January 2012 to June 2019 were collected and retrospectively analyzed.According to the regurgitation of atrioventricular valve,they were divided into Group A(slight or mild mitral and/or tricuspid insufficiency),Group B(moderate or above tricuspid insufficiency),Group C(moderate or above mitral insufficiency),and Group D(moderate or above mitral and tricuspid insufficiency).There were total 505 patients in the latter 3 groups,among which 124 underwent heart valve surgery.Results The severiry of atrioventricular valve regurgitation was constantly changing in the 693 patients.There were 65 patients with reduced reflux after medical treatment,and 23 of them underwent radiofrequency ablation of atrial fibrillation.Atrioventricular regurgitation was aggravated in 505 patients.Among the patients with moderate severe regurgitation,the non-operation patients had significantly longer history of atrial fibrillation,larger left ventricular diameter,and lower left ventricular systolic and diastolic functions than the operation patietns(P<0.05).The 124 patients underwent surgical treatment,but 1 patient died during perioperative period,and the others were followed up from 6 months to 94 months(averagely 63.03 months,54.61 to 71.44 months).Paired analysis showed that suegical treatment resulted in significantly decreased diameter of each atrium(P<0.001),improved cardiac function classification(P<0.001),and reduced score of Self-rating Anxiety Scale(SAS,P<0.001).Although some patients(24 cases)had lower LVEF after operation,there was no significant difference(P=0.067).The sinus rhythm was restored and maintained in 14(87.5%)of 16 patients who underwent valve surgery at the same time,and 18(16.8%)of 107 patients underwent valve surgery alone.Conclusion Surgical valve surgery should be carried out actively for the patients with end-stage atrial fibrillation with massive atrioventricular valve regurgitation,with the advantages of low risk and good quality of life.