梅氏微创心房颤动消融术治疗心房颤动合并射血分数降低型心力衰竭或射血分数轻度降低型心力衰竭的效果评价  

Efficacy of Mei Mini Maze procedure for treating atrial fibrillation complicated with heart failure with reduced ejection fraction or heart failure with mildly reduced ejection fraction

作　　者：姜兆磊[1] 曾千龙 林政宇 蔡捷 黄健兵[1] 刘浩[1] 马南[1] 丁芳宝[1] 梅举[1] JIANG Zhao-lei;ZENG Qian-long;LIN Zheng-yu;CAI Jie;HUANG Jian-bing;LIU Hao;MA Nan;DING Fang-bao;MEI Ju(Department of Cardiothoracic Surgery,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

出　　处：《中国心血管病研究》2025年第4期293-297,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(82170324);上海市科委科研计划项目(22QC1401100);上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD008)。

摘　　要：目的 评价梅氏微创心房颤动(房颤)消融术治疗房颤合并射血分数降低型心力衰竭(HFrEF)或射血分数轻度降低型心力衰竭(HFmrEF)的效果。方法 选取2020年4月至2022年10月上海新华医院应用梅氏微创房颤消融术治疗合并HFrEF或HFmrEF的房颤患者41例(女19例),其中持续性房颤15例,长程持续性房颤26例。平均年龄(63.4±11.5)岁,房颤病程(58.4±23.8)个月,左心房直径(44.3±3.7)mm,回顾分析患临床资料,总结房颤合并HFrEF或HFmrEF的微创外科治疗方法,评价其疗效。结果 全组患者均顺利完成梅氏微创房颤消融术。术后随访(28.0±9.4)个月,29例患者(70.7%)维持窦性心律,12例患者(29.3%)术后复发(4例持续性房颤,6例阵发性房颤,2例房扑)。37例(90.2%)患者房颤负荷较术前明显缓解。Kaplan-Meier曲线显示,术后1年时窦性心律维持率为(73.2±11.0)%。与术前相比,术后术后1年时患者左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)均有明显改善[(55.4±8.9)%比(42.9±5.6)%,(121.5±23.7)ml比(136.8±27.4)ml,(53.8±15.9)ml比(78.9±20.8)ml]。结论 梅氏微创房颤消融术可安全、有效地应用于房颤合并HFrEF或HFmrEF的治疗中,治疗效果满意。Objective To evaluate the efficacy of Mei Mini Maze procedure for treating atrial fibrillation combined with heart failure with reduced ejection fraction(HFrEF) or heart failure with mildly reduced ejection fraction(HFmrEF).Methods From April 2020 to October 2022,41 atrial fibrillation patients(19 females)combined with HFrEF or HFmrEF were treated with Mei Mini Maze procedure in Shanghai Xinhua hospital,including 15 cases of persistent atrial fibrillation and 26 cases of long-standing persistent atrial fibrillation.The average age was(63.4±11.5) years.The average duration of atrial fibrillation was(58.4±23.8) months.The average left atrial diameter was(44.3±3.7) mm.The average left ventricular ejection fraction(LVEF),left ventricular enddiastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were(42.9 ± 5.6),(136.8 ± 27.4) ml and(78.9±20.8) ml.The clinical data were analyzed respectively.Results All the patients successfully underwent Mei Mini Maze procedure.During the follow-up period of 28.0±9.4) months,29 patients(70.7%) maintained sinus rhythm,while 12 patients(29.3%) experienced atrial fibrillation recurrence(4 patients with persistent atrial fibrillation,6 patients with paroxysmal atrial fibrillation,and 2 patients with atrial flutter).The atrial fibrillation burden was significantly reduced in 37 patients(90.2%) after Mei Mini Maze.Kaplan-Meier curves showed that the sinus rhythm maintenance rate was(73.2 ± 11.0)% at 1 year postoperatively.Compared to the preoperative values,the patient's LVEF,LVEDV,and LVESV were significantly improvemed at 1 year postoperatively [(55.4±8.9)% vs.(42.9 ± 5.6)%,(121.5 ± 23.7) ml vs.(136.8 ± 27.4) ml,(53.8 ± 15.9) ml vs.(78.9 ± 20.8) ml].Conclusion Mei Mini Maze procedure can be safely and effectively applied in the treatment of atrial fibrillation combined with HFrEF orHFmrEF,which has satisfactory outcomes.

关 键 词：心房颤动 心力衰竭 梅氏微创心房颤动消融术 疗效 

分 类 号：R541.7[医药卫生—心血管疾病]