二尖瓣手术同期房颤射频消融在不同左房大小的近中期结果对比

Short-term and mid-term outcomes of radiofrequency ablation in patients underwent mitral valve surgery with different left atrial sizes

目的评价不同左心房直径(LAD)大小(LAD>45 mm或≤45 mm)的慢性瓣膜性房颤(AF)患者行外科改良双极射频消融术(BRFA)的近中期消融效果。方法回顾性分析2016年5月至2019年1月在中国人民解放军总医院心血管外科共完成心脏手术同期行改良双极BRFA共264例患者的临床资料,制定纳入及排除标准,并对两组患者不同LAD进行倾向性评分,共纳入A组(左心房直径LAD>45 mm)75例,B组(左心房直径LAD≤45 mm)75例;分析比较两组患者的术前一般资料、手术相关指标、术后病死率、并发症及窦性心律恢复情况。结果A组术后1周、半年、1年及2年窦性心律转复率分别为:84.0%、81.3%、73.3%和69.3%;B组术后1周、半年、1年及2年窦性心律转复率分别为:90.7%、88.0%、86.7%和84.0%,两组比较差异有统计学意义(P<0.05)。术后按标准华法林抗凝,两组患者术后近中期随访均未新发脑血管事件。结论二尖瓣手术同期采用改良MazeⅣ行BRFA治疗慢性长程持续性瓣膜性AF手术效果好,窦性心律转复成功率高。然而,手术后随时间延长,LAD越大越不容易维持窦性心律。

Objective To evaluate the short-term and mid-term outcomes of modified bipolar radiofrequency ablation in patients underwent mitral valve surgery with chronic valvular atrial fibrillation(AF)and different left atrial diameter(LAD).Methods The clinical data of 264 patients underwent mitral valve surgery and bipolar radiofrequency ablation simultaneously in our hospital from May 2016 to January 2018 were collected and analyzed retrospectively.The patients were divided into two groups according to different LAD(group A:LAD>45 mm,n=75,group B:LAD≤45 mm,n=75).The clinical data of general information,surgical results,postoperative mortality and complications,and recovery of sinus rhythm were analyzed between the two groups.Results 1 week,6 months,1 year and 2 years after surgical intervention,the sinus rhythm recovery rate of group A were 84.0%,81.3%,73.3%and 69.3%respectively,which were significantly different with those in group B(90.7%,88.0%,86.7%and 84.0%,P<0.05).Warfarin had been the standard therapy for patient after the surgery,and there were no new cerebrovascular events occurred in either of the two groups during short-term and mid-term follow-ups.Conclusion The modified bipolar radiofrequency ablation in patients with chronic valvular AF during mitral valve surgery was safe and reliable,with a high sinus rhythm recovery rate.However,the larger of the LAD,the more difficult it was to maintain sinus rhythm.