心脏不停搏冠状动脉旁路移植同期改良肺静脉隔离左心房消融治疗冠心病合并房颤的近期效果分析  

Clinical study on simultaneously modified pulmonary vein isolation and left atrial ablation during off-pump coronary artery bypass grafting

作　　者：李晖[1] 刘长城[1] 李海洋[1] Li Hui;Liu Changcheng;Li Haiyang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital University,Bejing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京10002

出　　处：《中华胸心血管外科杂志》2024年第5期284-287,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京医院管理局临床医学发展专项基金(XMLX202107)。

摘　　要：目的探讨心脏不停搏冠状动脉旁路移植同期改良肺静脉隔离左心房消融治疗冠心病合并房颤的手术效果。方法回顾性分析2021年1月至2023年8月期间在北京安贞医院心脏外科接受不停搏冠状动脉旁路移植同期改良肺静脉隔离左心房消融治疗冠心病合并房颤的76例患者临床资料,其中男57例,女19例;年龄48~76岁,平均(63.42±8.25)岁,中位房颤病程26个月。术后随访1年,复查24 h动态心电图,观察房颤复发情况。结果所有患者均顺利完成手术,无中转体外循环,无围手术期死亡、卒中和二次开胸止血。术后第1天转为窦性或交界心律69例(90.79%),术后中位住院时间7天,所有患者均康复出院,出院时仍维持窦性心律67例(88.16%)。术后1年维持窦性心律56例(73.68%),与术前比较差异有统计学意义(P<0.05)。结论本研究初步明确了心脏不停搏冠状动脉旁路移植同期改良肺静脉隔离左心房消融治疗冠心病合并房颤安全、可行,近期有效,中远期疗效需行多中心、大样本研究进一步证实。Objective To innovatively applicate and evaluate the efficacy of simultaneous off-pump coronary artery bypass grafting(OPCABG),modified pulmonary vein isolation and left atrial ablation treating coronary heart disease combined with atrial fibrillation.Methods From January 2021 to August 2023,a retrospective analysis was conducted on the clinical data of 76 patients who underwent OPCABG,modified pulmonary vein isolation and left atrial ablation in our department.There were 57 males and 19 females,aged(63.42±8.25)years,with a median duration of 26 months of atrial fibrillation.Follow up was conducted for 1 year after surgery,and 24-hour dynamic electrocardiogram was rechecked to observe the recurrence of atrial fibrillation.Results All patients successfully completed the surgery without any conversion to extracorporeal circulation,and no perioperative death.On the first day after surgery,there was a conversion to sinus or junctional rhythm in 69(90.79%)cases.The median postoperative hospitalization time was 7 days,with no postoperative cerebral infarction or complications of thoracotomy hemostasis.All patients recovered and were discharged,with a sinus rhythm maintained at 67(88.16%)upon discharge.Compared with preoperation,there were 56(73.68%)patients with sinus rhythm after 1 year of postoperative follow-up(P<0.05).Conclusion The simultaneous OPCABG,modified pulmonary vein isolation and left atrial ablation treating coronary heart disease with atrial fibrillation was safe,feasible,and effective.The mid-and long-term efficacy needs to be further confirmed through multicenter and large-scale studies.

关 键 词：心房颤动 冠心病 心房射频消融 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]