心脏瓣膜假体植入和外科消融迷宫手术治疗瓣膜病合并心房颤动  

Cardiac valve prosthesis implantation and surgical maze ablation for the treatment of valvular disease with atrial fibrillation

作　　者：马超 王辉山 韩劲松 尹宗涛 张锡祾 Ma Chao;Wang Huishan;Han Jinsong;Yin Zongtao;Zhang Xiling(Graduate School,General Hospital of Northern Theater Command,Jinzhou Medical University,Shenyang 110016,Liaoning Provinee,China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,Liaoning Province,China)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,辽宁省沈阳市110016 [2]中国人民解放军北部战区总医院心血管外科,辽宁省沈阳市110016

出　　处：《中国组织工程研究》2020年第28期4580-4587,共8页Chinese Journal of Tissue Engineering Research

基　　金：2017年辽宁省自然基金计划重点项目(20170540977),项目负责人:韩劲松。

摘　　要：背景:二尖瓣疾病患者二尖瓣置换与二尖瓣瓣环成形术后的心房颤动发生率较高,迷宫手术是心房颤动外科治疗的金标准,而人工瓣膜与瓣环对迷宫手术的影响不明确。目的:评价瓣膜性房颤外科消融迷宫术后窦性心律-左心房收缩功能的变化规律,以及瓣膜置换或瓣环植入是否影响窦性心律-左心房收缩功能的恢复。方法:纳入2013年10月至2017年10月中国人民解放军北部战区总医院收治的324例二尖瓣病变伴随持续性或长期持续性心房颤动患者,接受迷宫手术后均进行人工瓣膜置换或人工瓣环植入治疗。分别于出院时,术后1,3,6,12,24个月进行心电图和超声心动图随访。应用多因素Cox回归模型分析左心房收缩力恢复的预测因素。试验已通过中国人民解放军北部战区总医院(原沈阳军区总医院)伦理委员会批准。结果与结论:①2例患者(0.6%)在围术期死亡,其余322例患者均获得2年随访,随访期间无人工材料相关不良事件发生;②患者术后左心房收缩力恢复率逐步升高,至术后1年,左心房收缩力与窦性心律共存的一致性较好(Kappa系数≥0.75,P<0.05),术后2年时窦性心律和左心房收缩力恢复率分别为86.6%和85.1%;③Cox多元回归分析显示,较长术前心房颤动时间、较大术前左心房内径、术后3个月左心房收缩力缺失和冷冻消融术式是迷宫术后中晚期(>3个月)窦性心律和左心房收缩力恢复的共同预测因素(P<0.05),较长术前心房颤动持续时间、较大术前左心房内径、切开与缝合术式是左心房收缩力中晚期恢复的预测因素(P<0.05),瓣膜置换或瓣环植入、材料类型及假体型号不是心房颤动和力中晚期恢复的影响因素(P>0.05);④ROC曲线分析显示,术前心房颤动时间与术前左心房内径对左心房收缩力恢复的最佳预测临界值分别为36.5个月(敏感度90.5%,特异性93.7%)和60.5 mm(敏感度93.8%,特异性85.0%);⑤结果�BACKGROUND: Patients with mitral valve disease have a higher incidence of atrial fibrillation after mitral valve replacement and mitral annuloplasty. Maze surgery is the gold standard for surgical treatment of atrial fibrillation. The effect of artificial valve and valve ring on maze surgery is not clear. OBJECTIVE: To evaluate the changes of sinus rhythm-left atrial contractive function after surgical maze ablation of valvular atrial fibrillation and whether valve replacement or valve ring implantation affects the recovery of sinus rhythm-left atrial contractive function. METHODS: From October 2013 to October 2017, 324 patients who underwent surgical maze ablation due to mitral valve lesions associated with persistent or long-term persistent atrial fibrillation in the General Hospital of Northern Theater Command were enrolled. All patients were treated with artificial valve replacement or artificial valve ring implantation after maze operation. The patients were followed up by electrocardiogram and echocardiography at discharge and 1, 3, 6, 12 and 24 months after procedure. A multivariate Cox analysis of predictive factors for left atrial contractive function recuperation was applied. This study was approved by the Medical Ethics Committee of General Hospital of Northern Theater Command(original General Hospital of Shenyang Military Region of Chinese PLA). RESULTS AND CONCLUSION:(1) Two patients(0.6%) died during the perioperative period, and the remaining 322 patients were followed up for 2 years. There were no adverse events related to artificial materials during the follow-up.(2) The recovery rate of left atrial contractive function increased gradually after procedure. The coexistence consistency of left atrial contractive function and sinus rhythm was good until 1 year after surgery(Kappa coefficient ≥ 0.75, P < 0.05). Two years after maze procedure, the recovery rates of sinus rhythm and left atrial contractive function were 86.6% and 85.1%, respectively.(3) Cox multiple regression analysis showed that lo

关 键 词：心房颤动 瓣膜性心脏病 迷宫手术 心房收缩力 生物材料 材料相容性 人工瓣环 心脏瓣膜假体 

分 类 号：R459.9[医药卫生—治疗学] R318.11[医药卫生—临床医学]