摘要
目的评价微创心脏瓣膜手术同期双房冷冻消融治疗合并心房颤动(房颤)的安全性和疗效。方法 2014年1月至2015年9月上海交通大学医学院附属新华医院心胸外科经右胸切口行微创二尖瓣手术同期双房冷冻消融治疗合并房颤47例,其中男26例、女21例,年龄42~69岁。二尖瓣病因:风湿性心脏病31例,退行性病变16例。房颤病程2~11年,均为长程持续性房颤;左房直径43~60 mm。结果 47例患者顺利完成心脏瓣膜手术及房颤冷冻消融术,无转为正中开胸手术者。体外循环时间95~146(120.3±12.3)min;主动脉阻断时间82~115(93.3±7.7)min;冷冻消融时间32~48(38.6±4.5)min。围术期无死亡病例。术后住院时间5~16(7.9±1.9)d。出院时,44例(44/47,93.6%)维持窦性心律。术后随访6~26(14.4±5.4)个月,41例(41/47,87.2%)维持窦性心律,术后1年累计窦性心律维持率为86.3%±5.8%。结论微创心脏瓣膜手术同期应用双房冷冻消融治疗合并房颤是安全、有效的,其早、中期效果满意。
Objective To evaluate the safety and efficacy of biatrial Cox Maze Ⅳ cryoablation for concomitant atrial fibrillation （AF） during minimally invasive valve surgery. Methods A total of 47 patients （26 males, 21 females, age of 42-69 years） with mitral valve disease and long-standing persistent AF received minimally invasive biatrial Cox Maze Ⅳ cryoablation procedure combined with mitral valve surgery through right minithoracotomy from January 2014 to September 2015. The etiology of mitral valve disease was rheumatic （n=31） and degenerative （n=16）. AF duration ranged from 2 to 11 years. Diameter of the left atrium ranged from 43 to 60 mm. Concomitant biatrial Cox Maze Ⅳ cryoablation procedure was performed through right lateral minithoracotomy. Results All 47 patients successfully underwent this minimally invasive concomitant biatrial Cox Maze Ⅳ cryoablation procedure and valve surgery. No patient needed conversion to sternotomy during the surgery. The mean cardiopulmonary bypass time, aortic cross-clamp time and cryoablation time was 95-146 （120.3±12.3） min, 82-115 （93.3±7.7） min and 32-48 （38.6±4.5） min, respectively. There was no death perioperatively. The average postoperative length of hospital stay was 5-16 （7.9±1.9） d. At discharge, 44 patients （44/47, 93.6%） maintained sinus rhythm. At a mean follow-up of 6-26 （14.4±5.4） months, sinus rhythm was maintained in 41 patients （41/47, 87.2%）. Cumulative maintenance rate of normal sinus rhythm without AF recurrence at one year postoperatively was 86.3%±5.8%. Conclusion Biatrial Cox Maze Ⅳ cryoablation procedure is safe, feasible and effective for AF during concomitant minimally invasive valve surgery.
作者
梅举
姜兆磊
汤敏
马南
刘浩
尹航
何毅
MEI Ju JIANG Zhaolei TANG Min MA Nan LIU Hao YIN Hang HE Yi(Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.Chin)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2017年第1期25-29,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家临床重点专科项目
国家自然科学基金项目(81570290)
上海市科委科研计划项目(15411952600)
上海申康医院发展中心新兴前沿技术项目(SHDC12014107)
上海新华医院院级科研课题(15YJ13)
关键词
心房颤动
二尖瓣
冷冻消融
微创手术
Atrial fibrillation
mitral valve
cryoablation
minimally invasive surgery
