摘要
目的观察瓣膜手术同期行射频消融迷宫手术治疗心房颤动的疗效，探讨外科手术治疗瓣膜病合并心房颤动的临床价值。方法2003年1月至2011年12月，149例心脏瓣膜病合并心房颤动患者接受瓣膜手术同期行射频消融迷宫手术。记录心电图变化，比较术前与术后心脏超声心动图指标（LAD、LVDS、EF）的变化及心脏功能的恢复情况。随访6～90个月。结果二尖瓣成形术21例，二尖瓣置换术89例（其中生物瓣置换术35例），主动脉瓣置换术32例（其中生物瓣置换术11例），三尖瓣成形术46例，三尖瓣置换术3例，左房血栓清除术48例。体外循环时间（82．1±17．8）min，主动脉阻断时间（37．8±25.3）min。双极射频消融121例，单、双极联合射频消融28例，射频消融时间12-38（17．4±5．1）min。手术后即刻，心房颤动全部消失，窦性心律133例，节性心律14例，Ⅲ度房室传导阻滞2例。围术期死亡3例，死亡率2．0％（3／149），其中2例为严重低心排综合征，1例多器官功能衰竭。术后1个月，窦性心律121例（82．9％），结性心律8例（5．5％），心房扑动5例（3．4％），房颤心律12例（8．2％），Ⅲ度房室传导阻滞1例（0．6％），安置永久起搏器。随访时间3～90个月，随访率78．8％（115／146）。随访期间死亡9例（4例心源性死亡，2例脑梗塞死亡，3例脑出血死亡）。106例随访到的存活病例，93例恢复窦性心律，转复率87．7％。随访超声心动图可见左心房及左心室舒张末内径均较术前减小，而左心室射血分数较术前无明显变化。结论瓣膜病合并心房颤动同期行瓣膜手术及射频消融迷宫手术，手术安全性高，远期疗效确切。抗凝并发症仍是瓣膜置换手术远期的主要并发症及致死原因之一，瓣膜成形或生物瓣置换联合射频迷宫手术可能降低此风险。
Objective To evaluate the outcome of surgical treatment for atrial fibrillation with modify maze procedure by radiofreqnency ablation during valve surgery, and to explore the clinical application of surgical treatment of atrial fibrillation in heart valve disease. Methods Data was collected as a part of prospective registry of valve surgery through Jan. 2003 to Dec. 2011. One hundred and forty-nine patients were recruited. All patients were treated with radiofrequency ablation during valve surgery. Preoperative records of electro-cardiogram and echo- cardiogram including the diametere of left atrium, EF and those postoperative records after surgery were compared to determine the efficacy of the surgery. The time of following up ranged from six months to ninety months. ResultsAll patients recruited were undergone valve procedure and treatment for atrial fibrillation by radiofrequency abla- tion. Twenty-one cases were undergone valvuloplasty procedure, eighty-nine cases were undergone mitral replace- ment including thirty-five cases of bioprosthetic replacement, thirty-two cases were undergone aortic valve replace- ment involving eleven cases of bioprosthetic replacement, forty-six cases were undergone tricuspid valvoplasty, three cases were undergone replacement of tricuspid valve, and forty-eight eases were undergone left atrial thrombectomy. The CPB time was （ 82.1 ±17.8 ）min, the time of clamping aorta was （ 37.8±25.3 ）min. One hundred and twenty-one patients were undergone bipolar radiofrequency ablation during procedure, and twenty-eight cases were undergone bipolar and unipolar radiofrequency ablation during procedure. The radiofrequency ablation time was 12-38 （17.4±5.1） min. There was no atrial fibrillation immediately afler the procedure. There were one hun- dred and thirteen patients with sinus rhythm, fourteen patients with junctional rhythm, two patients with III o atial ventricular block. Three patiens died （2.0%）. One patient was dead of mulciple organ failure. The other two pa- tients were dead of severe low cardiac output syndrome. The others were discharged from hospital and all of them were accept fbllow-up. There were one hundred and twenty-one patients with sinus rhythm, eight patients with junctional rhythm, five patients with auricular flutter, twelve patients with atrial fibrillation and one patients with no atial ventricular block at one month after discharged. The follow-up time ranged from six months to ninety months, the rate of follow-up was 78.8%（115/146）. Nine patients were dead during follow-up, four cardiac death, two cerebral infarction death and three cerebral hemorrhage death. There were ninety-three patients with si- nus rhythm （87.7%）. The diameter of left atrium, left ventricular end-diastolic diameter shrinked compared with the data of pre-operation, while there was no significant change in EF. Conclusion The surgical treatment for a- trial fibrillation with modify maze procedure by radiofrequency ablation during valve surgery was safe and simply, and the long-term outcome was satisfied. Anticoagulant complications remain the main complication of valve re- placement surgery and one of the leading causes of death, valvuloplasty or biological valve replacement combined RF maze procedure may reduce this risk.
出处
《中国心血管病研究》
CAS
2013年第1期9-12,共4页
Chinese Journal of Cardiovascular Research
基金
基金项目：国家自然基金项目（项目编号：39700059）
辽宁省自然科学基金项目（项目编号：20092114）：沈阳市科学技术项目（项目编号：F11-264-1-75）
关键词
心房颤动
射频消融术
瓣膜病
迷宫手术
Atrial fibrillation
Radiofrequency ablation
Valvular heart diseas
MAZE procedure
