单一胸骨上段小切口浅低温行全主动脉弓置换联合冰冻象鼻支架植入术后新发心房颤动相关性研究

Analysis of atrial fibrillation after total arch replacement with frozen elephant trunk under mild hypothermic circulatory arrest via a single upper hemisternotomy approach

目的探讨单一胸骨上段小切口浅低温行全主动脉弓置换联合冰冻象鼻支架植入术后新发心房颤动(简称房颤)的相关性。方法选取自2020年8月至2021年6月北部战区总医院收治的行全主动脉弓置换术联合冰冻象鼻支架植入术的80例急性Stanford A型主动脉夹层患者为研究对象。将患者随机分为中度低温组和浅低温组,每组各40例。记录患者术前、术中和术后临床指标,并通过酶联免疫吸附法检测血清中转化生长因子-β(TGF-β)和基质金属蛋白酶-9(MMP-9)表达情况。结果浅低温组患者手术停循环时间明显短于中度低温组,最低鼻咽温明显高于中度低温组,差异有统计学意义(P<0.05);浅低温组实施主动脉瓣悬吊成形患者比例明显低于中度低温组,差异有统计学意义(P<0.05)。两组患者在ICU停留时间、呼吸机辅助时间、住院时间、围术期输血、二次机械通气以及术后不良反应的发生情况等比较,差异均无统计学意义(P>0.05)。中度低温组患者体外循环停机前TGF-β和MMP-9明显低于浅低温组,差异有统计学意义(P<0.05)。对术后新发房颤进行单因素分析结果显示,术后新发房颤患者年龄明显高于术后未新发房颤患者,差异有统计学意义(P<0.05)。结论从单一胸骨上段小切口浅低温行全主动脉弓置换联合冰冻象鼻支架植入术,不会提高术后新发房颤的发生率,高龄可能是该术式下新发房颤的相关危险因素。

Objective To evaluate the atrial fibrillation after total arch replacement with frozen elephant trunk(FET)stent implantation under mild hypothermic circulatory arrest via a single upper hemisternotomy approach.Methods A retrospective study was performed on 80 patients with acute type A aortic dissection who underwent total aortic arch replacement combined with FET stent implantation from August 2020 to June 2021.All patients were randomly divided into moderate hypothermic circulatory arrest group and mild hypothermic circulatory arrest group,with 40 cases in each group.The perioperative outcomes of patients were recorded,and the serum level of transforming growth factor-β(TGF-β)and matrix metalloprotein-9(MMP-9)was detected by enzyme-linked immunosorbent assay.Results The circulatory arrest time in the mild hypothermic circulatory arrest group were significantly lower than that in the moderate hypothermic circulatory arrest group,the lowest nasopharyngeal temperature in the mild hypothermic circulatory arrest group were significantly higher than that in the moderate hypothermic circulatory arrest group,and the proportion of aortic suspension shaping in the mild hypothermic circulatory arrest group were significantly less than that in the moderate hypothermic circulatory arrest group,the difference was statistically significant(P<0.05).However,there was no significant difference between two groups in the ICU stay,ventilation time,hospitalization duration,blood transfusion,secondary ventilation,and adverse events.The level of TGF-βand MMP-9 in the mild hypothermic circulatory arrest group were significantly higher than those in moderate hypothermic circulatory arrest group,the difference was statistically significant(P<0.05).The monofactor analysis demonstrated that the age of patients with postoperative atrial fibrillation was significantly higher than that of patients without it,the difference was statistically significant(P<0.05).Conclusion The strategy total arch replacement with FET stent implantation under mild hypothermic circulatory arrest via a single upper hemisternotomy approach don’t increase the incidence of postoperative atrial fibrillation,and age may be one of the risk factors for postoperative atrial fibrillation in this minimally invasive procedure.