心肺转流用于迷宫Ⅲ手术单中心经验

Strategies for cardiopulmonary bypass management in Cox-maze Ⅲ surgery:a single institution experience

目的总结本中心100例Cox迷宫Ⅲ治疗心脏外科疾病合并慢性心房颤动(AF)的心肺转流(CPB)管理策略的经验。方法收集2015年7月至2020年8月,本科共施行迷宫Ⅲ手术治疗心脏外科疾病合并慢性AF患者100例。所有患者均在中低温CPB下采用切和缝的方法同期完成迷宫Ⅲ及心脏外科手术。结果术后早期死亡3例(3%),CPB时间89~274(175.1±35)min。主动脉阻断时间56~180(114.8±23.5)min。二次开胸止血2例(2%,非迷宫切口),气管切开4例,持续性肾替代治疗7例,术后安装永久心脏起搏器4例(出院前和术后3个月各2例)。术后住院天数9~48(15±9)d。出院时窦性心律84例(86.6%,84/97),房颤5例(5.2%,5/97),交界性心律8例(8.2%,8/97)。结论良好的CPB管理、术中心肌保护及血液保护是迷宫Ⅲ手术成功的重要保障。

Objective To summarize the experience of cardiopulmonary bypass(CPB)management strategy for 100 patients with chronic atrial fibrillation(AF)under the treatment of cardiac and Cox-maze Ⅲ surgery in our center.Methods From July 2015 to August 2020,a total of 100 patients combined with chronic AF were treated with cardiac Cox-maze Ⅲ surgery in our department.All patients underwent Cox-maze Ⅲ and cardiac surgery at the same time using a unipolar radiofrequency ablation under CPB.Results Three cases died in early postoperation(3%),and the CPB time was 89-274(175.1±35)min.The aortic clamping time was 56-180(114.8±23.5)min.There were 2 cases of re-operation for hemostasis(2%,non Cox-maze Ⅲ incision),4 cases of tracheotomy,7 cases of continuous renal replacement therapy,and 4 cases of permanent cardiac pacemaker(2 cases before discharge and 2 cases 3 months after operation).Postoperative hospital stay was 9-48(15±9)days,84 patients had sinus rhythm(86.6%,84/97),5 patients had AF(5.2%,5/97),and 8 patients had borderline rhythm(8.2%,8/97)at discharge.Conclusion Good CPB management,myocardial protection and blood conservation are very important guarantees for the success of Cox-maze Ⅲ.