冷冻消融迷宫手术治疗老年二尖瓣病变合并持续性或长期持续性心房颤动的倾向性评分匹配分析

Cryomaze ablation in treatment of elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation:A propensity-score matching study

目的评价二尖瓣病变合并持续性或长期持续性心房颤动(atrial fibrillation,AF)的老年患者行二尖瓣手术和冷冻消融(cryoablation,CB)迷宫手术的安全性及疗效。方法筛选2014年5月—2018年7月因持续性或长期持续性AF合并二尖瓣病变就诊于北部战区总医院心胸外科的患者144例,其中<60岁69例(非老年组),男18例、女51例,平均年龄(52.07±5.56)岁;≥60岁75例(老年组),男32例、女43例,平均年龄(65.23±4.29)岁。并将两组患者进行倾向性评分匹配分析。两组均于二尖瓣手术同期行CB迷宫手术。出院后随访2年,比较两组围术期安全性指标和术后疗效指标。结果经倾向性评分匹配后,两组各纳入56例患者。两组各随访时间点的窦性心律转复率均在85%以上,心功能分级为Ⅰ级或Ⅱ级,较术前显著改善,但组间差异均无统计学意义(P>0.05);两组围术期各项指标中,老年组冠状动脉旁路移植术多于非老年组、术后ICU停留时间长于非老年组(P<0.05),其余各项指标差异均无统计学意义(P>0.05)。结论老年二尖瓣病变合并持续性或长期持续性AF患者实施二尖瓣手术和CB迷宫手术安全,近期疗效满意。

Objective To evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.Methods From May 2014 to July 2018,144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery,General Hospital of Northern Theater Command were selected.Among them,there were 69 patients in a non-elderly group(<60 years)including 18 males and 51 females aged 52.07±5.56 years,and 75 patients in an elderly group(≥60 years)including 32 males and 43 females aged 65.23±4.29 years.A propensity-score matching(PSM)study was conducted to eliminate confounding factors.Both groups underwent mitral valve surgery and cryoablation at the same time.A 2-year follow-up was conducted after discharge from the hospital,and the perioperative and postoperative efficacy indexes were compared between the two groups.Results After PSM analysis,there were 56 patients in each group.The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%,and the cardiac function was graded asⅠorⅡ,which was significantly improved compared with that before the surgery,but there was no statistical difference between the two groups(P>0.05).Among the perioperative indicators of the two groups,the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group(P<0.05),and the differences in other indicators were not statistically different(P>0.05).Conclusion The mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe,and the short-term outcome is satisfactory.