Combined Low-dose Aspirin and Warfarin Anticoagulant Therapy of Postoperative Atrial Fibrillation Following Mechanical Heart Valve Replacement

The safety and efficacy of combined low dose aspirin and warfarin therapy in patients with atrial fibrillation after mechanical heart valve replacement were evaluated. A total of 1016 patients （620 females, mean age of 36.8-4-7.7 years） admitted for cardiac valve replacement and complicated with atrial fibrillation after surgery were randomly divided into study （warfarin plus 75-100 mg aspirin） or control （warfarin only） groups. International normalized ratio （INR） and prothrombin time were main- tained at 1.8-2.5 and 1.5-2.0 times the normal values, respectively. Thromboembolic events and major bleedings were registered during the follow-up period. Patients were followed up for 24±9 months. The average dose of warfarin in the study and control groups was 2.91±0.83 mg and 2.88±0.76 mg, respec- tively （P〉0.05）. The incidence of overall thromboembolic events in study group was lower than that in control group （2.16% vs. 4.35%, P=0.049）. No statistically significant differences were found in hem- orrhage events （3.53% vs. 3.95%, P=-0.722） or mortality （0.20% vs. 0.40%, P=0.559） between the two groups. Combined low dose aspirin and warfarin therapy in the patients with atrial fibrillation following mechanical heart valve replacement significantly decreased thromboembolic events as compared with warfarin therapy alone. This combined treatment was not associated with an increase in the risk of major bleeding or mortality.

Clinical and prognostic implications of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

AIM: To study a cohort of consecutive patients under-going transcatheter aortic valve implantation (TAVI) and compare the outcomes of atrial fibrillation (AF) patients vs patients in sinus rhythm (SR). METHODS: All consecutive patients undergoing TAVI in our hospital were included. The AF group comprised patients in AF at the time of TAVI or with history of AF, and were compared with the SR group. Procedural, echocardiographic and follow-up variables were compared. Likewise, the CHA 2 DS 2-VASC stroke risk score and HAS-BLED bleeding risk score and antithrombotic treatment at discharge in AF patients were compared with that in SR patients. RESULTS: From a total of 34 patients undergoing TAVI, 17 (50%) were allocated to the AF group, of whom 15 (88%) were under chronic oral anticoagulation. Patients in the AF group were similar to those in the SR group except for a trend (P = 0.07) for a higher logistic EuroSCORE (28% vs 19%), and a higher prevalence of hypertension (82% vs 53%) and chronic renal failure (17% vs 0%). Risk of both stroke and bleeding was high in the AF group (mean CHA 2 DS 2-VASC 4.3, mean HAS-BLED 2.9). In the AF group, treatment at discharge included chronic oral anticoagulation in all except one case, and in association with an antiplatelet drug in 57% of patients. During a mean follow-up of 11 mo (maximum 32), there were only two strokes, none of them during the peri-procedural period: one in the AF group at 30 mo and one in the SR group at 3 mo. There were no statistical differences in procedural success, and clinical outcome (survival at 1 year 81% vs 74% in AF and SR groups, respectively, P = NS). CONCLUSION: Patients in AF undergoing TAVI show a trend to a higher surgical risk. However, in our cohort, patients in AF did not have a higher stroke rate compared to the SR group, and the prognosis was similar in both groups.

Incidence, pathophysiology, predictive factors and prognostic implications of new onset atrial fibrillation following transcatheter aortic valve implantation

1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,

Risk Factors for Prognosis after the Maze Ⅳ Procedure in Patients with Atrial Fibrillation Undergoing valve Surgery

The present study evaluated risk factors related to persistent atrial fibrillation(AF)at discharge(AF-d)and recurrent atrial fibrillation(rAF)and all-cause death after the maze IV procedure.Two hundred nineteen patients(63 female,aged 52.5±8.8 years)with valve disease and persistent AF undergoing valve surgery and the maze IV procedure in our center between 2015 and 2016 were included.Baseline demographic and clinical data were obtained by review of medical records.The median follow-up period was 27 months(interquartile range 21-34 months)in our patient cohort.The primary end point was all-cause death.The secondary end point was AF-d or rAF.rAF is defined as AF recurrence at 3 months or later after the procedure.Twenty-eight patients(12.8%)died during follow-up.Multiple logistic regression analysis showed that thrombocytopenia,elevated serum total bilirubin level,a larger right atrium,AF-d,and rAF were independent determinants for all-cause death after the maze IV procedure after adjustment for age,sex,and clinical covariates,including New York Heart Association class III/IV disease,hypertension,and aortic regurgitation,while valvular disease duration and left atrial diameter greater than 80.5 mm were independent determinants for AF-d,and thrombocytopenia,elevated serum total bilirubin level,higher mean pulmonary artery pressure,and AF-d were independent predictors for rAF.In conclusion,thrombocytopenia,elevated serum total bilirubin level,an enlarged right atrium,AF-d,and rAF are independent predictors of all-cause death in patients undergoing the maze IV procedure.

Role of thrombus precursor protein in assessment of anticoagulation in patients with atrial fibrillation after mechanical heart valve replacement

Objective: To explore the role of thrombus precursor protein (TpP) in assessment of anticoagulation and predict the risk of thromboembolism in the patients with atrial fibrillation (AF) after mechanical heart valve replacement. Methods: TpP plasma concentration and international normalization ratio (INR) were measured in 45 patients with atrial fibrillation and 45 patients with sinus rhythm both after mechanical heart valve replacement. Twenty patients with non valvular heart diseases were selected as the control. Furthermore, the patients with AF were divided into groups based on different TpP plasma concentration and TpP plasma concentration and INR were analyzed. Results: After mechanical heart valve replacement, those with AF had higher TpP plasma concentration than those with sinus rhythm. It was found that discordancy existed between INR and TpP plasma concentration in the patients with AF. There were 28 AF patients with TpP plasma concentration lower than 6 μg/ml and without bleeding, who might be at the optimal anticoagulant state. The 95% confidence of the mean INR value was 1.90-2.30 in these patients and TpP plasma concentration was between 2.84-5.74 μg/ml. Conclusion: Patients with AF might face higher risk of thromboembolism after mechanical valve replacement; INR between 1.90-2.30 and TpP plasma concentration between 2.84-6 μg/ml might be the optimal anticoagulant range for patients with AF after mechanical valve replacement.

Atrial electromechanical coupling parameters after transcatheter aortic valve replacement

The article entitled Effect of transcatheter aortic valve replacement on P-wave duration, P-wave dispersion and left atrial size by Dursun, et al. has contributed to our knowledge regarding the positive effects of transcatheter aortic valve replacement （TAVR） procedure on atrial electrical remodeling. In this study, TAVR procedure led to a decrease on P-wave duration and P-wave dinner,inn

Pathological study on right atrium myocardium in rheumatic heart disease patients with atrial fibrillation

Objective: To study the pathological basis of right atrial fibrillation in rheumatic heart disease (RHD) patients with atrial fibrillation (AF). Methods: Twenty-nine patients with mitral valve replacement of RHD were divided into AF group (n=13) and sinus rhythm group (SN group) (n=16). There was no significant statistical difference in clinical factors between the 2 groups. During the operation of valve replace-ment, the samples of right atrial appendages were taken and the qualitative and quantitative study were made by light microscopy and electron microscopy. Results: (1) Light microscope: The interstitial fibrosis and the arrangement of myocardium was more disordered in AF group than that in SN group. However, no statistic difference was found in interstitial fibrosis and cellar hypertrophy degree between the 2 groups. (2) Electron microscope: Mitochondrial crosta broke and dissolved obviously in AF group. The mitochondrial volume in AF group was smaller than that in SN group. Volume density, average area and average perimeter in AF group were less than that in SN group ; specific surface in AF group was bigger than that in SN group. There was significant difference of above factors between the 2 groups; but there was no significant difference of surface density and numerical density on area in the 2 groups. Volume density of myofibril in AF group and SN group were less than that in SN group. (3)Split of Intercalated disc(ID) gap was found in AF group, and there was marrowing and floccular substance in ID gap. Conclusion : There were significant differences in the pathological changes of right atrial myocardium between AF and SN with RHD, these changes may be the im-portant pathological basis for RA fibrillation of AF patients with RHD.

房颤射频消融术对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响

目的探究房颤射频消融术(RA)对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响。方法选取我院2022年2月至2023年3月接受心脏搭桥合并心脏瓣膜手术患者50例,随机数字表法将其分为观察组25例(房颤RA治疗)与对照组25例(保守药物治疗)。对比两组手术相关指标、不同时间点心肌损伤[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)]及心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]指标,术后随访3个月,统计患者窦性心律转复及心脑血管不良事件(MACCE)发生率。结果观察组体外循环时间比对照组长,总住院时间比对照组短,差异均有统计学意义(P<0.05)。两组术后血清CK-MB、cTnI、NT-proBNP水平均呈现先上升、后下降趋势(P<0.05);观察组术后2 h血清CK-MB、cTnI、NT-proBNP水平均显著高于对照组(P<0.05),但两组间术后48 h上述指标差异均无统计学意义(P>0.05)。术后3个月,观察组比对照组LVEF[(49.78±2.35)%vs.(45.03±2.17)%]显著上升,LVEDD[(54.93±4.30)mm vs.(57.38±4.16)mm]、LVESD[(39.62±4.37)mm vs.(46.15±5.23)mm]显著下降(P<0.05)。观察组术后第1天、出院时及术后3个月窦性心律转复率均显著高于对照组(P<0.05),术后3个月内MACCE两组对比差异无统计学意义(P>0.05)。结论房颤RA能有效改善心脏搭桥合并心脏瓣膜手术患者心功能,提高窦性心律转复率,短期预后好,但可能引发一过性心肌酶上升。

三尖瓣反流与心房颤动的研究进展

三尖瓣反流(TR)和心房颤动(AF)是心血管疾病领域中两种常见且经常共存的心血管疾病。TR作为一种影响心脏三尖瓣正常功能的疾病,可导致心力衰竭等其他严重心血管并发症。AF作为最常见的心律失常之一,其发生增加了卒中、心力衰竭和心源性死亡等风险。它们可相互作用和/或加重,导致患者病情发生显著恶化。现综述TR导致AF的作用机制及其治疗策略等最新研究进展,以指导临床实践并改善患者预后。

Cox迷宫Ⅲ联合心脏瓣膜手术后急性肾损伤风险预测模型的构建与评价

目的:探讨Cox迷宫Ⅲ联合心脏瓣膜手术后发生急性肾损伤(AKI)的危险因素,建立AKI风险发生的列线图预测模型,并验证其效能。方法:回顾性分析2015年10月至2023年6月在东部战区总医院行Cox迷宫Ⅲ联合心脏瓣膜手术的160例合并心房颤动的心脏瓣膜病患者的临床资料。经单因素及多因素logistic回归分析明确术后发生AKI的独立危险因素,建立列线图预测模型,并通过受试者工作特征(ROC)曲线、校准曲线及决策曲线分析(DCA)验证其效能。结果:160例患者中,82例(51.3%)出现AKI,其中10例(6.3%)需行连续性肾脏替代治疗。多因素Logistic回归分析显示,年龄、糖尿病、术前1周使用造影剂、术前纽约心脏病协会(NYHA)心功能分级≥3级、围手术期血浆输注、术后乳酸峰值是Cox迷宫Ⅲ联合心脏瓣膜手术后发生AKI的独立危险因素。列线图预测模型的ROC曲线下面积(AUC)为0.847(95%CI:0.788~0.906),敏感度为70.73%,特异性为84.62%。校准曲线具有较高的拟合度,DCA提示该模型对临床决策具有重要意义。结论:Cox迷宫Ⅲ联合心脏瓣膜手术后AKI的发生率较高,高龄、合并糖尿病、术前1周使用造影剂、术前NYHA心功能分级≥3级、围手术期血浆输注、术后高乳酸血症的患者术后更易发生AKI。该研究构建的列线图预测模型预测能力良好,有助于术后AKI的早期预测及干预。

二尖瓣环运动受损对持续性心房颤动患者心房功能性二尖瓣反流的影响

目的 观察二尖瓣环运动受损对持续性心房颤动(AF)患者心房功能性二尖瓣反流(AFMR)的影响。方法前瞻性纳入44例接受射频消融(RFA)治疗的持续性AF患者,对比RFA前1日与RFA后3个月二维经胸超声心动图和经食管实时三维超声心动图(RT-3D TEE)参数;根据二尖瓣有效反流口面积(EROA)评估AFMR,计算总体瓣环面积(AA)变化率及收缩前期AA变化率;以RFA前后EROA差值为因变量,筛选影响RFA后3个月AFMR改善程度的治疗前超声相关因素。结果 相比治疗前,RFA后3个月左心房整体纵向应变及左心室射血分数均升高,左心房内径、左心房容积、EROA、瓣环前后径、瓣环周长、AA、瓣叶面积及非平面角均缩小,而总体AA变化率及收缩前期AA变化率均增大(P均<0.05)。RFA前收缩前期AA变化率为持续性AF患者RFA后3个月AFMR改善程度的独立影响因素(P<0.05)。结论 持续性AF患者二尖瓣环运动功能受损主要表现为收缩前期瓣环运动减退,并影响其AFMR程度。

心脏瓣膜置换术后新发心房颤动患者血清Angpt1、内皮素-1水平变化及其临床意义

目的:探究心脏瓣膜置换术后新发心房颤动(AF)患者血清血管生成素-1(Angpt1)、内皮素-1(ET-1)的水平变化,并分析二者的临床意义。方法:选择2020年1月~2022年3月于本院行心脏瓣膜置换术的130例患者,根据术后7d有无AF分为无AF组(72例)及AF组(58例)。采用ELISA法检测两组血清Angpt1、ET-1水平;采用Pearson法分析AF患者血清Angpt1、ET-1水平的相关性;采用ROC曲线分析血清Angpt1、ET-1水平对此类患者术后发生AF的预测价值;采用Logistic回归分析此类患者术后发生AF的影响因素。结果:AF组左心房内径(LAD)、NYHA心功能Ⅳ级比例、体外循环时间均显著高于无AF组(P<0.05或<0.01)。术后1d,与无AF组比较,AF组血清Angpt1水平显著降低,ET-1水平显著升高(P均<0.001)。Pearson相关分析显示,AF患者血清Angpt1水平与ET-1水平呈显著负相关(r=-0.366,P=0.005)。ROC分析显示,血清Angpt1、ET-1水平联合预测心脏瓣膜置换术后AF发生的曲线下面积(AUC)显著高于二者单独预测(Z=2.761、1.998,P=0.006、0.046)。多因素Logistic回归分析显示LAD、NYHAⅣ级、体外循环时间及术后ET-1是此类患者术后发生AF的独立危险因素(OR=1.471~1.739,P<0.05或<0.01),而术后Angpt1是其独立保护因素(OR=0.634,P=0.004)。结论:心脏瓣膜置换术后新发AF患者术后血清Angpt1水平显著降低,ET-1水平显著升高,联合检测Angpt1、ET-1水平对术后AF发生的预测价值较高。

心房颤动与窦性心律的风湿性心脏瓣膜病病人左心耳长链非编码RNA表达差异研究

目的:探讨风湿性心脏瓣膜病合并慢性心房颤动或窦性心律病人左心耳长链非编码RNA(lncRNAs)的表达差异。方法:选取风湿性心脏瓣膜病心房颤动病人和风湿性心脏病窦性心律病人各3例,术中取少许左心耳组织,通过高通量二代测序、基因本体(GO)富集分析、京都基因和基因组百科全书(KEGG)通路显著性富集分析对lncRNAs靶基因进行生物功能分析,反向推测lncRNAs功能。结果:心房颤动组和窦性心律组比较存在差异lncRNAs共38条(P<0.05),表达上调15条,表达下调23条,心房颤动组较窦性心律组有显著性差异的mRNAs有1475条(P<0.05),表达上调635条,表达下调840条。结论:风湿性心脏瓣膜病病人左心耳中与心房颤动相关的差异表达的lncRNAs可能与心房颤动电重构、钙处理异常机制有关,且可能与代谢途径、心肌收缩、心肌细胞肾上腺素能信号传导、丝裂原活化蛋白激酶(MAPK)信号通路、环磷酸鸟苷(cGMP)-蛋白激酶G(PKG)信号通路、钙信号通路相关。

血尿酸、脑钠肽对主动脉瓣置换术后房颤发生的预测分析

目的:分析血尿酸、脑钠肽(Brain Natriuretic Peptide,BNP)对主动脉瓣置换术后房颤发生的预测价值。方法:选择2020年1月至2023年8月期间在南阳市中心医院拟行主动脉瓣置换术治疗的117例患者作为研究对象,以术后2 w内房颤发生情况作为观察终点并将患者分为发生组与未发生组。采集并比较两组患者一般资料及实验室指标,测定两组术前血尿酸、BNP水平,并分析血尿酸、BNP水平对主动脉瓣置换术后房颤发生的预测价值。结果:发生组左房容积、血尿酸、BNP水平均高于未发生组,差异有统计学意义(P<0.05);经Logistic回归分析结果显示,左房容积增加、血尿酸及BNP水平升高是主动脉瓣置换术后房颤发生的危险因素(OR>1,P<0.05);绘制受试者工作特征曲线,结果显示血尿酸、BNP及联合对主动脉瓣置换术后房颤发生预测的曲线下面积均>0.7,预测价值较好,且以联合预测性能最佳。结论:血尿酸、BNP水平异常高表达可能会增加主动脉瓣置换术后房颤发生风险,联合检测两种指标水平或可提高对术后房颤发生的预测价值。

Outcome of Cox Maze procedure concomitant with mitral valve operation in treatment of atrial fibrillation

Atrial fibrillation （AF） is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral valve operation. The Maze procedure, developed by Cox and associates,15 has been used in patients undergoing a mitral valve operation. Restoration of normal sinus rhythm and atrial contraction in such patients have been reported by some groups. This study will summarize retrospectively a group of patients who underwent the Cox Maze procedure for the treatment of AF associated with rheumatic mitral valve disease in China.

Effect of prophylactic oral amiodarone on postoperative outcomes in patients with preoperative atrial fibrillation undergoing cardiac valve surgery for rheumatic heart disease

Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.

Sequential multidisciplinary minimally invasive therapeutic strategy for heart failure caused by four diseases: A case report

BACKGROUND The coexistence with patent ductus arteriosus(PDA),mitral valve prolapse(MVP),atrial fibrillation(AF)and hyperthyroidism is extremely rare and complex.The optimal therapeutic strategy is difficult to develop.CASE SUMMARY A 27-year-old female with PDA,MVP,AF and hyperthyroidism presented with severe dyspnea.Given that a one-stage operation for PDA,MVP and AF is high risk,we preferred a sequential multidisciplinary minimally invasive therapeutic strategy.First,PDA transcatheter closure was performed.Hyperthyroidism and heart failure were simultaneously controlled via medical treatment.Video-assisted thoracoscopic mitral valve repair and left atrial appendage occlusion were performed when heart failure was controlled.Under this therapeutic strategy,the patient’s sinus rhythm was restored and maintained.Two years after the treatment,the symptoms of heart failure were relieved,and the enlarged heart was reversed.CONCLUSION Sequential multidisciplinary therapeutic strategies,which take advantage of both internal medicine and surgical approaches,might be reasonable for this type of disease.

A Seven-year Experience for The Surgical Radiofrequency Ablation in Patients With Atrial Fibrillation

Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.

二尖瓣置换同期行优化的迷宫Ⅳ术治疗二尖瓣疾病合并心房颤动的临床疗效

目的:探讨二尖瓣置换同期行优化的迷宫Ⅳ术,在治疗二尖瓣疾病合并心房颤动患者中的临床疗效。方法:2016年01月至2020年12月,136例二尖瓣疾病合并心房颤动患者在我科手术治疗,回顾性分析临床资料。其中63例患者二尖瓣置换术同期行经典的迷宫Ⅳ术(经典组),73例患者二尖瓣置换术同期行优化的迷宫Ⅳ(优化组)。经典组男28例,女35例,年龄38~70岁,平均(56.7±12.5)岁;优化组男33例,女40例,年龄42~72岁,平均(58.6±14.3)岁。分析两组患者的一般资料、术前超声心动图结果、围术期资料、出院时及随访心电图和超声心动图结果,分析二尖瓣置换同期行优化的迷宫Ⅳ术,在治疗二尖瓣疾病合并心房颤动患者中的临床疗效。结果:优化组主动脉阻断时间、体外循环时间、手术操作时间、术后呼吸机辅助时间和胸腔引流量均短于经典组,差异有统计学意义(P<0.05)。两组并发症发生率、ICU滞留时间和术后住院时间等,差异无统计学意义(P>0.05)。两组出院时、术后3、6、12个月窦性心律维持率,差异无统计学意义(P>0.05);两组术后6个月LAD、LVEDD、LVEF、肺动脉压及心功能分级等,差异无统计学意义(P>0.05)。结论:优化的迷宫Ⅳ同期二尖瓣置换术治疗二尖瓣疾病合并心房颤动,能缩短手术时间,术后恢复快,随访结果满意。

经心外膜左心耳闭合技术在心脏瓣膜病合并房颤患者中的疗效分析:单术者经验总结

目的:探讨单术者将术中经心外膜左心耳闭合技术应用于伴有心房颤动的接受瓣膜手术患者的临床疗效。方法:选取2019年6月-2021年12月蚌埠医学院第一附属医院收治的59例患有心房颤动并接受瓣膜手术的患者作为研究对象。根据术中是否应用经心外膜左心耳闭合技术,将患者分为夹闭组(n=29)和非夹闭组(n=30),比较两组患者手术前相关基础资料、围术期各项指标及术后随访数据等。结果:两组患者的年龄、性别、有无左心房内血栓、术前心功能及其他合并基础疾病相比较,差异均无统计学意义(P>0.05)。两组患者术前心脏彩超测量值比较,差异均无统计学意义(P>0.05);夹闭组术前射血分数高于非夹闭组(P<0.05)。两组患者间手术方式比较,差异无统计学意义(P>0.05)。两组患者围术期指标及随访数据比较,夹闭组患者的总手术时间长于非夹闭组,差异有统计学意义(P<0.05);两组患者体外循环时间、阻断升主动脉时间、术后住院时间、术后短期内心房颤动复发及脑卒中事件发生率比较,差异均无统计学意义(P>0.05)。结论:对患有心房颤动并接受瓣膜手术的患者,应常规施行经心外膜左心耳闭合技术,该技术简单实用、安全经济。