冷冻联合射频消融治疗二尖瓣病变合并房颤的疗效分析  

Analysis of the effect of cryotherapy combined with radiofrequency ablation in the treatment of mitral valve disease with atrial fibrillation

作　　者：高鹏凯 姜兆磊[1] 梅举[1] 黄健兵[1] 汤敏[1] 刘浩[1] 蔡捷 沈赛娥[2] 丁芳宝[1] GAO Peng-kai;JIANG Zhao-lei;MEI Ju;HUANG Jian-bing;TANG Min;LIU Hao;CAI Jie;SHEN Sai-e;DING Fang-bao(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,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,上海市200092 [2]上海交通大学医学院附属新华医院麻醉与重症医学科,上海市200092

出　　处：《中国心血管病研究》2023年第4期323-327,共5页Chinese Journal of Cardiovascular Research

基　　金：国家临床重点专科;国家自然科学基金项目(82170324,81974023,82000308);上海市科委科研计划项目(22QC1401100,21S31904700,20Y11910700)。

摘　　要：目的 评价冷冻联合射频消融治疗二尖瓣病变合并房颤的疗效。方法 回顾性分析上海交通大学医学院附属新华医院2019年06月至2021年06月完成的75例接受同期二尖瓣手术和冷冻联合射频消融治疗房颤患者的临床资料。其中男34例,女41例,年龄39~77岁。术前二尖瓣病变情况:二尖瓣狭窄11例,二尖瓣关闭不全37例,二尖瓣狭窄合并关闭不全27例。房颤中位病程3(0.75,5)年,其中持续性房颤26例,长程持续性房颤49例。左心房内径(52.29±6.97)mm;左心室射血分数(59.19±9.17)%。全身麻醉、体外循环下施行手术,先行冷冻联合射频房颤消融术,再行二尖瓣手术。结果 所有患者均顺利完成心脏瓣膜手术及冷冻联合射频房颤消融术。围术期死亡1例,为二、三尖瓣修复及房颤消融患者,因肺部感染于术后59 d死于呼吸衰竭。出院时,70例(94.6%)维持窦性心律。术后随访12~36(23.0±6.7)个月,失访1例;随访期间发生1例患者死亡,术后1年死于心力衰竭。2例患者置入心脏永久起搏器(1例窦房结功能障碍,1例房室传导阻滞)。Kaplan-Meier生存曲线表明,术后第1年累计窦性心律维持率为(90.3±3.5)%,术后第2年累计窦性心律维持率为(87.1±4.6)%。结论 冷冻联合射频消融可安全、有效地应用于二尖瓣病变合并房颤治疗中,早、中期疗效满意。Objective To evaluate the effect of cryoablation combined with radiofrequency ablation in the treatment of mitral valve disease with atrial fibrillation(AF).Methods The clinical data of 75 patients(34 males and 41 females,age of 39-77 years)with AF who underwent mitral valve surgery and cryoablation combined with radiofrequency ablation in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2019 to June 2021 were retrospectively reviewed.The preoperative mitral valve disease situations were with 11 cases of mitral stenosis,37 cases of mitral insufficiency and 27 cases of mitral stenosis and insufficiency.The median course of AF was 3(0.75,5)years,including 26 cases of persistent AF and 49 cases of long-term persistent AF.LAD was(52.29±6.97)mm and LVEF was(59.19±9.17)%.Surgery was performed under general anesthesia and extracorporeal circulation.Cryosurgery combined with radiofrequency AF ablation followed by mitral valve surgery.Results All the patients successfully underwent mitral valve surgery and cryosurgery combined with radiofrequency ablation of AF.One patient died of respiratory failure 59 days after the operation due to pulmonary infection;and the patient underwent mitral and tricuspid valve repair and atrial fibrillation ablation.70 patients(94.6%)maintained sinus rhythm at discharge.Follow-up time ranged from 12 to 36(23.0±6.7)months and 1 case was lost.One patient died of heart failure 1 year after the operation.Permanent cardiac pacemakers were implanted in 2 patients(1 case of sinus node dysfunction,1 case of atrioventricular block).Kaplan-Meier survival curve showed that the cumulative sinus rhythm maintenance rate was(90.3±3.5)%in the first year and(87.1±4.6)%in the second year after the operation.Conclusion Cryoablation combined with radiofrequency ablation would be safely and effectively used in the treatment of mitral valve disease with AF,and the early and mid-term results of the treatment satisfactory.

关 键 词：二尖瓣病变 心房颤动 冷冻消融 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]