心外膜左心耳夹闭在心房颤动外科治疗中的应用及早期临床效果  

Application and early clinical outcome of epicardial left atrial appendage clipping in surgical treatment of atrial fibrillation

作　　者：冯磊 李洪利[1] 李杨[1] 刘燕晖[1] 尚学斌[1] 李超 丁瑞田 齐德林 FENG Lei;LI Hongli;LI Yang;LIU Yanhui;SHANG Xuebin;LI Chao;DING Ruitian;QI Delin(Department of Cardiac Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]北京市首都医科大学宣武医院心脏外科,100053

出　　处：《心肺血管病杂志》2021年第10期1041-1045,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医科大学宣武医院院级课题(XWJL-2019024)。

摘　　要：目的:探讨心外膜左心耳夹闭在心房颤动外科治疗中的安全和有效性,为心房颤动治疗提供临床选择。方法:回顾性分析2019年1月至2020年12月,首都医科大学宣武医院心脏外科收治的单组心心房颤动动病例的临床资料,其中男15例,女15例,年龄39~86岁,平均年龄(63.7±9.5)岁。阵发性心房颤动22例,持续性心房颤动8例,其中长期持续性心房颤动5例。入组患者中,孤立性心房颤动7例,合并冠心病18例,瓣膜病2例,房间隔缺损1例,同时合并冠心病和瓣膜病2例。所有患者均接受心外膜左心耳夹闭治疗及其他相应手术。患者出院前均行头颅磁共振及心脏CTA检查,以评估左心耳闭合效果、心耳夹移位情况以及有无心房颤动相关脑卒中。结果:所有患者行心外膜左心耳夹闭术,其中单纯行左心耳夹闭7例,同期联合单纯冠状动脉移植术18例,联合冠状动脉旁路移植术和二尖瓣置换术1例,联合冠状动脉移植术、二尖瓣成形和射频消融术1例,联合房间隔缺损修补和三尖瓣成形1例,联合二尖瓣成形和置换术各1例。16例患者采用传统胸骨正中切口,14例采用小切口技术,其中左侧肋间小切口12例,胸骨倒"L"型小切口2例。7例孤立性心房颤动患者采用电视胸腔镜下左侧肋间小切口技术,手术时间44~66 min,平均(56.0±7.9)min。围手术期死亡患者2例,死因均为心力衰竭继发多脏器衰竭。术后随访6~10个月,平均(6.8±1.4)个月;随访期间,1例患者因长期营养不良、肺部和手术切口感染并发呼吸衰竭和败血症死亡;所有随访患者无心房颤动相关卒中症状及体征,头颅磁共振检查未见新发脑梗死病灶;心脏CTA显示左心耳血流沟通及左心房血栓形成,无心耳夹移位、变形表现。结论:心外膜左心耳夹闭是治疗心房颤动安全可行的外科方案,可作为临床外科医师治疗心房颤动的新策略。Abjective:The aim of this study was to assess the safety and efficacy of surgical left atrial appendage(LAA)exclusion with epicardial clip in treatment of atrial fibrillation(AF),and to propose an effective therapeutic option for AF.Methods:Clinical data of a single group of 30 patients with AF diagnosed and treated by the Department of Cardiac Surgery of Xuanwu Hospital of Metropolitan Medical University,from January 2019 to December 2020 were retrospectively analyzed,including 15 males and 15 females,aged from 39 to 86 years old with an average age of 63.7 years.Among them,there were 22 cases with paroxysmal AF,8 with persistent AF,and 5 with long-term persistent AF.7 patients were diagnosed with isolated AF,18 with concomitant coronary heart disease(CAD),2 with combined cardiac valvular disease(CVD),1 with atrial septal defect(ASD),and 2 with CAD and CVD preoperatively.All patients underwent surgical LAA exclusion with an epicardial clip or other correspondingly concomitant surgical procedures.Before discharge,brain magnetic resonance imaging(MRI)and cardiac computed tomography angiography(CTA)were arranged for all patients recovered postoperatively to confirmed the existence of displacement of atrial appendage clip or new occurrence of AF-related stroke.Results:Surgical procedure of epicardial clipping of LAA was successfully completed in all patients.Isolated epicardial LAA occlusion was conducted in 7 cases,and simultaneous procedure including coronary artery bypass grafting(CABG)in 18 cases,CABG and mitral valve replacement in 1 case,CABG combined with mitral valvuloplasty and radiofrequency ablation in 1 case,mitral valvuloplasty in 1 case,mitral valve replacement in 1 case,and combination of atrial septal defect closure and tricuspid valvuloplasty in 1 case,respectively.Median sternotomy was accomplished in 16 patients,and minimally invasive incisions performed in 14 patients,including incision through left intercostal space in 12 patients and"inverted L"sternotomy in 2 cases.Surgical procedure of left a

关 键 词：心房颤动 左心耳 心耳夹 脑卒中 

分 类 号：R54[医药卫生—心血管疾病]