冷冻消融迷宫术治疗风湿性二尖瓣病变合并心房颤动及巨大左心房的安全和有效性

The safety and effectiveness of cryoablation maze procedure in the treatment of rheumatic mitral valve disease with atrial fibrillation and giant left atrium

目的:评估冷冻消融迷宫手术和二尖瓣手术治疗风湿性二尖瓣病变合并心房颤动及巨大左心房患者的安全性和有效性。方法:选取2014年10月至2018年6月,在我院行冷冻消融迷宫手术的心房颤动合并风湿性二尖瓣病变的162例患者,分为两组:大左心房组(LAD≥60 mm)62例,非大左心房组(LAD<60 mm)100例,于出院时,术后1、3、6、9、12、24个月进行随访。用倾向性评分(PSM)的方法匹配后对比其安全性及疗效指标。结果:大左心房组有1例患者(0.6%)在围术期死亡,其余患者完成2年随访。安全性指标:体外循环时间、主动脉阻断时间、术中出血量间,差异无统计学意义(P>0.05),应用临时起搏器比例,差异有统计学意义(P<0.05);早期并发症总发生率:两组分别为18.2%(8/44)和11.1%(5/45),差异无统计学意义(P>0.05);术后疗效指标:两组术后窦性心律恢复率:两组分别为79.5%(35/44)和84.4%(38/45),左心房收缩功能恢复率:术后2年两组分别为68.2%(30/44)和68.9%(31/45),组间,差异无统计学意义(P>0.05)。结论:冷冻消融迷宫手术和二尖瓣手术治疗风湿性二尖瓣病变合并心房颤动及巨大左心房安全性较好,近期疗效满意。

Objective: To evaluate the safety and effectiveness of cryoablation maze surgery and mitral valve surgery in the treatment of rheumatic mitral valve disease with atrial fibrillation and huge left atrium. Methods: 162 patients with atrial fibrillation combined with rheumatic mitral valve disease who underwent cryoablation maze surgery in our hospital from October 2014 to June 2018 were divided into 2 groups: large left atrium group(LAD≥60 mm) 62 cases, 100 cases of non-large left atrium group(LAD<60 mm) were followed up at 1, 3, 6, 9, 12, and 24 months after the operation. Use the propensity score(PSM) method to compare its safety and efficacy indicators after matching. Results: One patient(0.6%) in the large left atrium group died during the perioperative period, and the remaining patients completed a 2-year follow-up. Safety indicators: There was no statistical difference between cardiopulmonary bypass time, aortic occlusion time, and intraoperative blood loss(P>0.05). The difference in the proportion of temporary pacemakers was statistically significant(P<0.05);The total incidence of complications: 18.2%(8/44) and 11.1%(5/45) in the large left atrium group and the non-large left atrium group, respectively, there was no statistical difference between the groups(P>0.05);Curative effect indicators: the recovery rate of postoperative sinus rhythm in the two groups: 79.5%(35/44) and 84.4%(38/45) in the large left atrium group and the non-large left atrium group, respectively. The recovery rate of left atrial systolic function: postoperative The two-year large left atrium and non-large left atrium groups were 68.2%(30/44) and 68.9%(31/45), respectively, and there was no significant difference between the groups(P>0.05). Conclusions: The cryoablation labyrinth surgery and mitral valve surgery are safe in the treatment of rheumatic mitral valve disease with atrial fibrillation and giant left atrium, and the short-term efficacy is satisfactory.