梅氏微创消融术治疗心房颤动合并左室收缩功能受损的疗效评价  

Clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function

作　　者：马南[1] 姜兆磊[1] 梅举[1] 卢荣鑫 汤敏[1] 丁芳宝[1] MA Nan;JIANG Zhaolei;MEI Ju;LU Rongxin;TANG Min;DING Fangbao(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200092,P.R.China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科

出　　处：《中国胸心血管外科临床杂志》2020年第1期68-72,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81570290);上海市科委科技项目(15411952600)

摘　　要：目的研究梅氏微创消融术治疗心房颤动(房颤)合并左室收缩功能受损的临床结果。方法2010年6月至2017年12月,86例房颤合并左室功能受损的患者接受了梅式微创消融术,其中男54例、女32例,年龄43~71(60.7±5.9)岁。阵发性房颤12例,持续性房颤27例,长程持续性房颤47例,房颤病史(6.5±4.8)年,CHA2DS2-VASc房颤受损评分(2.2±1.1)分。患者左房直径(46.9±3.8)mm,左室直径(51.7±4.6)mm。术前患者左室射血分数42.2%±4.7%。全组患者全身麻醉后接受梅氏微创消融术,消融路线为3个环形消融加3条线性消融。使用切割闭合器切除左心耳。用消融笔消融Marshall韧带和心外膜自主神经节。结果全组患者均成功完成手术,无中转开胸手术,无围手术期死亡。77例(89.5%)患者出院时维持窦性心律。术后80例患者保持随访,平均随访时间(27.2±12.1)个月,72例患者维持窦性心律。术后总体左室射血分数47.1%±6.2%,窦性心律组的射血分数48.2%±5.8%,非窦性心律组的射血分数41.6%±5.8%,两组差异有统计学意义(P<0.05)。多因素回归分析,左房直径(HR=1.485,95%CI 1.157~1.906,P<0.05)和射血分数提升是否超过10%(HR=18.800,95%CI 1.674~189.289,P<0.05)与房颤术后复发密切相关。Kaplan-Meier曲线分析进一步显示,术后射血分数提升超过10%的患者房颤复发率明显低于其他患者(P<0.05)。结论梅氏微创消融术治疗房颤合并左室收缩功能受损安全、有效,可以恢复患者窦性心律,有助于左室功能的改善,减少心力衰竭的发生,从而防止房颤合并心力衰竭的恶性循环。Objective To study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.Methods From June 2010 to December 2017,86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females,with an average age of 60.7±5.9 years.Among them,12 were with paroxysmal,27 were with persistent and 47 were with longstanding persistent atrial fibrillation.The mean atrial fibrillation duration was 6.5±4.8 years.CHA2DS2-VASc score was 2.2±1.1.The mean diameter of left atrium was 46.9±3.8 mm.The mean diameter of left ventricle was 51.7±4.6 mm.The preoperative ejection fraction was 42.2%±4.7%.All patients received Mini Maze procedure after general anesthesia.The ablation included 3 annular ablations and 3 linear ablations.The left atrial appendage was excised by Endo-Gia.Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.Results Eighty-six patients successfully completed the procedure without transition to thoracotomy.There was no death during the perioperative period.Seventy-seven patients(89.5%)maintained sinus rhythm at discharge.Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm.The overall postoperative left ventricular ejection fraction was 47.1%±6.2%.The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%,and the ejection fraction of the non-sinus group was 41.6%±5.8%(P<0.05).Multivariate regression analysis showed a left atrial diameter(HR=1.485,95%CI 1.157-1.906,P<0.05)and an increase in ejection fraction over 10%(HR=18.800,95%CI 1.674-189.289,P<0.05)were closely related to postoperative recurrence.Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10%(P<0.05).Conclusion Mini Maze procedure is safe and effective in the treatment of atrial fibril

关 键 词：心房颤动 胸腔镜 消融 左室功能不全 

分 类 号：R541.75[医药卫生—心血管疾病]