CAJ | 학술논문

目的回顾性分析瓣膜置换术同期射频消融手术治疗合并瓣膜性心脏病房颤的效果,及影响手术效果的可能因素,指导临床选择房颤消融手术获益最大的病例.方法选取2010年9月至2011年9月我院心胸外科行房颤射频消融+瓣膜置换手术的患者50例.其中风湿性心脏瓣膜病34例,非风湿性瓣膜病16例,术中消融路线相同,左心耳结扎,左房明显增大者行左房减容手术.术后常规口服可达龙6月,随访患者半年,复查心电图了解心律转归情况.结果50例患者均痊愈出院,无手术死亡,无出血,无脑梗,无Ⅲ度房室传导阻滞,无需安装永久起搏器.14例出现房颤复发或未转复,36例恢复窦性心律,手术成功率为72%.随访6个月,期间无患者死亡,术后心功能均有改善,生活质量显著提高.两组患者在左房内径,瓣膜病类型及房颤病程有统计学差异;而术前心功能NYHA分级,射血分数,体外循环时间,主动脉阻断时间及年龄无统计学意义.结论直视下心脏射频消融是瓣膜置换手术中同期治疗房颤最有效方法,其成功率较高,无严重并发症.
목적회고성분석판막치환술동기사빈소융수술치료합병판막성심장병방전적효과,급영향수술효과적가능인소,지도림상선택방전소융수술획익최대적병례.방법선취2010년9월지2011년9월아원심흉외과행방전사빈소융+판막치환수술적환자50례.기중풍습성심장판막병34례,비풍습성판막병16례,술중소융로선상동,좌심이결찰,좌방명현증대자행좌방감용수술.술후상규구복가체룡6월,수방환자반년,복사심전도료해심률전귀정황.결과50례환자균전유출원,무수술사망,무출혈,무뇌경,무Ⅲ도방실전도조체,무수안장영구기박기.14례출현방전복발혹미전복,36례회복두성심률,수술성공솔위72%.수방6개월,기간무환자사망,술후심공능균유개선,생활질량현저제고.량조환자재좌방내경,판막병류형급방전병정유통계학차이;이술전심공능NYHA분급,사혈분수,체외순배시간,주동맥조단시간급년령무통계학의의.결론직시하심장사빈소융시판막치환수술중동기치료방전최유효방법,기성공솔교고,무엄중병발증.
Objective] This study retrospectively anlalyzed AF recurrence rate in most patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department.We compared the information and clinical date in the sinus rhythm(SR)group with in tle AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidence to select patients who can benefit most from this type of surgery.[Methods] From June 2010 to June 2011,50 patients with rheumatic heart disease(RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgron with with the same metlod.Preoperative and intraoperative data was retrospectively co1lected and al patients were folowed up six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided al patients to the A (sinus rhythm)grope and B(atrial fibrilation/ atrial flutter) grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.[Results] Al the patients recoverd.None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean folow-up,period of 6 months.At the last folow-up,sinus rhythm was shown in 72%(36/50)patients.The left atrial diameter,AF duration and Valve disease types were predictors of recurrence of AF.Age,left ventricular ejection factor,aortic clump time,cardiopulmonaqby bypass time showed no significant difference between the two gropes.[Conclusion] RF ablation concomitant with valve replacement is an effective way to treat AF for those patients who need open heart Surgery at the same time.