闭合左心耳对二尖瓣机械瓣置换合并巨大左心房心房颤动患者的远期效果  

Long-term outcomes of occlusion of left atrial appendage in patients with atrial fibrillation during mechanical mitral valve replacement with giant left atrium

作　　者：李雨琪 叶青[2] 杜中涛[1] 贾明[1] 王坚刚[2] LI Yuqi;YE Qing;DU Zhongtao;JIA Ming;WANG Jiangang(Department of Cardiac surgery Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所瓣膜与心房颤动外科,100029

出　　处：《心肺血管病杂志》2025年第3期277-281,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金面上项目(82170311)。

摘　　要：目的:比较单纯闭合左心耳与闭合左心耳基础上联合射频消融在二尖瓣机械瓣置换合并巨大左心房(左心房前后径>65mm)的心房颤动患者的远期疗效。方法:选取2015年1月至2019年12月,在北京安贞医院接受二尖瓣机械瓣置换合并巨大左心房的心房颤动患者282例,最终纳入249例患者为研究对象,并根据干预措施分为两组,单纯闭合左心耳(缝闭或结扎)为观察组(n=67),在闭合左心耳基础上联合射频消融为对照组(n=182),中位随访36个月,比较围术期指标、远期死亡、主要并发症(血栓栓塞事件、严重心力衰竭再入院)以及心房颤动转复情况。结果:观察组术前左心房径明显大于对照组,且合并左心房血栓比例高,而体外循环时间、心肌阻断时间明显低于对照组(P均<0.05)。观察组中心房颤动或心房扑动率显著高于对照组(P<0.05),而永久起搏器置入率差异无统计学意义(P>0.05)。生存分析显示远期生存率,术后5年免于血栓栓塞发生率,及免于严重心力衰竭再入院率差异均无统计学意义(P>0.05)。结论:对于二尖瓣机械瓣置换合并巨大左心房的心房颤动患者等,单纯闭合左心耳后窦性心律维持率低,但并未增加血栓栓塞及严重心力衰竭再入院的风险。Objective:To compare the long-term efficacy of only left atrial appendage occlusion and combined radiofrequency ablation in patients with atrial fibrillation who underwent mechanical mitral valve replacement with a giant left atrium(left atrial anterior posterior diameter>65 mm).Methods:From January 2015 to December 2019,included 282 patients with atrial fibrillation underwent mechanical mitral valve replacement with a giant left atrium in Beijing Anzhen Hospital.Finally,67 patients who only underwent left atrial appendage occlusion(suture or ligation)were included in the observation group while 182 patients who underwent radiofrequency ablation and left atrial appendage occlusion(suture or ligation)in the control group.The median follow-up was 36 months.The perioperative variables,long-term death,main complications(thromboembolic events,readmission for severe heart failure)and conversion of atrial fibrillation were compared.Results:Left atrial diameter in the observation group was significantly larger than that in the control group,and the proportion of left atrial thrombosis was higher;however,the cardiopulmonary bypass time and crossclamp time were significantly lower than those in the control group(all P<0.05).The rate of atrial fibrillation or atrial flutter in the observation group was significantly higher than that in the control group(P<0.05),but there was no significant difference in the rate of permanent pacemaker(P>0.05).The survival analysis found that there was all no significant difference in the long-term survival rate,five-year freedom off thromboembolism and readmission for severe heart failure(P>0.05).Conclusions:For patients with atrial fibrillation who underwent mechanical mitral valve replacement with a giant left atrium,the maintenance rate of sinus rhythm after left atrial appendage occlusion was low,but it does not increase the risk of thromboembolism and readmission for severe heart failure.

关 键 词：心房颤动 射频消融 左心耳 二尖瓣机械瓣置换 巨大左心房 

分 类 号：R54[医药卫生—心血管疾病]