迷宫Ⅳ型手术中对二尖瓣峡部线采取双极射频消融联合"切-缝"技术的安全性和疗效分析

Safety and efficacy of bipolar radiofrequency ablation combined with"cut-and-sew"technique for the mitral isthmus line in mazeⅣprocedure

目的探讨在迷宫Ⅳ型手术中采取双极射频消融(radiofrequency ablation,RFA)联合"切-缝"技术(改良法)实现二尖瓣峡部(mitral isthmus,MI)线性病变,以减少术后环二尖瓣房扑/房速的发生。方法回顾性分析138例二尖瓣手术同期行迷宫Ⅳ型手术的房颤患者。MI线采取标准的RFA法和改良法两种方式并据此展开分组。比较术后窦性心律转复率及房扑/房速发生率等。结果围术期内,改良组1例疑因心源性休克和感染性休克死亡。随访2年,未发生死亡及卒中事件。不依赖Ⅰ/Ⅲ类抗心律失常药物术后6、12、24个月的窦性心律转复率,改良组为91.0%、89.7%、88.5%,RFA组为89.7%、84.5%、81.0%(P>0.05)。术后两年房速/房扑发生率,改良组低于RFA组(5.1%对15.3%,P=0.044)。RFA组的手术设备成本为改良组的1.5倍。房颤早期复发是房颤复发的独立危险因素。结论在二尖瓣手术同期行迷宫Ⅳ型手术中,MI线采取双极RFA联合"切-缝"技术是安全可行,术后房扑/房速发生率低于RFA法,降低了现有的医疗成本,能被更多的患者和地区接受。

Objective To reduce peri-mitral atrial flutter/tachycardia(AFL/AT),this study modified the ablation method of the mitral isthmus(MI)by adopting bipolar radiofrequency ablation(RFA)combined with"cut-and-sew"technique.Methods This was a clinical retrospective study,involving a total of 138 consecutive patients with AF who underwent a mitral valve surgery and concomitant mazeⅣprocedure.According to methods of MI linear lesion,patients were divided into the modified group and the RFA group.The primary end points are maintenance of sinus rhythm(SR)rate and the incidence of AFL/AT.Results During the perioperative period,one patient in the modified group died of suspected cardiogenic shock and septic shock.Follow up for two years,no deaths or stroke events occurred.The proportion of 6-,12-,and 24-month maintenance of SR off classⅠ/Ⅲantiarrhythmic drugs after surgery were 91.0%,89.7%,and 88.5%in the modified group and 89.7%,84.5%,and 81.0%in the RF group,respectively(P>0.05).The incidence of postoperative AFL/AT was 5.1%in the modified group and 15.3%in the RF group(P=0.044).The healthcare facility use expense in the RF group was 1.5 times that in the modified group.Early recurrence of AF was an independent risk factor for AF recurrence.Conclusion In the mitral valve surgery and concomitant mazeⅣprocedure,the modified method of bipolar RF ablation combined with"cut-and-sew"technique for the MI line is safe and feasible.Its incidence of postoperative AFL/AT is lower than that of the RF method,which reduces existing medical costs and could be accepted by more patients and regions.