人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣环扩张伴发心房颤动

摘要

BACKGROUND:For patients with degenerative mitral annulus dilatation complicated by atrial fibrilation, atrial fibrilation is needed to be treated concomitant with artificial valve ring implantation. Although Cox maze III procedure is the gold standard for treatment of atrial fibrilation, its safety has been questioned. OBJECTIVE:To evaluate the safety of artificial valve rings implantation and Cox Maze III procedure for treatment of degenerative mitral annulus dilatation complicated by atrial fibrilation. METHODS: A total of 43 patients with degenerative mitral annulus dilatation and atrial fibrilation were enroled and were randomly divided into test group (n=21) and control group (n=22). Patients in the test group were treated with mitral valvuloplasty and Cox Maze III procedure. Patients in the control group were only treated with mitral valvuloplasty. RESULTS AND CONCLUSION: (1) Intraoperative safety indexes: the durations of cardiopulmonary bypass and aortic clamping. and the incidence of hemoglobinuria in the test group were higher than those in the control group (P < 0.001). There was no significant difference in the urine output between these two groups. (2) Postoperative safety indexes: the incidence of atrial dysrhythmia (i.e., any atrial dysrhythmia other than atrial fibrilation), proportion of patients requiring a temporary pacemaker and hospital stays in the test group were higher than those in the control group (P < 0.05). There were no significant differences in the secondary-thoracotomy bleeding rate and incidence of stroke between these two groups. (3) Postoperative outcomes: the rates of cardioversion to achieve sinus rhythm at the day of surgery and at discharge in the test group were significantly higher than those in the control group (P < 0.001). At discharge, patients in both groups were al at NYHA functional class Ior II. Echocardiography showed trace to mild mitral regurgitation and complete closure of the tricuspid valve. There were no significant differences in the left atrial diameter, left ventricular diameter, left ventricular volume, and ejection fraction between these two groups. However, the proportions of mitral and tricuspid valve peak A-waves were significantly higher than those in the control group (P < 0.001). These results show that artificial valve ring implantation and Cox Maze III procedure is a safe and effective method for treating degenerative mitral annulus dilatation complicated by atrial fibrilation during operation.%背景：对退行性二尖瓣关闭不全合并心房颤动患者，需要在行二尖瓣人工瓣环置入治疗时同期处理心房颤动问题，迷宫Ⅲ型手术虽是治疗心房颤动的金标准，但其安全性遭到质疑。目的：评价人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣环扩张伴发心房颤动的安全性。方法：纳入退行性二尖瓣关闭不全合并心房颤动患者43例，按随机数字表法分两组治疗，试验组(n=21)施行二尖瓣成形和迷宫Ⅲ型手术，对照组(n=22)仅施行二尖瓣成形。结果与结论：①术中安全性指标：试验组体外循环时间、主动脉阻断时间、血红蛋白尿发生率高于对照组(P <0.001)，两组尿量无差异。②术后安全性指标：试验组房性心律失常发生率、临时起搏器应用比例和住院时间高于对照组(P <0.05)，两组间二次开胸止血率、脑卒中发生率无差异。③术后疗效：试验组术后当天与出院时的窦性心律转复率均明显高于对照组(P <0.001)。出院时，两组心功能均恢复为NYHAⅠ级或Ⅱ级，超声心动图显示二尖瓣反流均在微量或轻度以下，三尖瓣均关闭良好，两组间左心房内径、左心室内径、左心室容积和射血分数无差异，但试验组跨二尖瓣A峰和跨三尖瓣A峰比例明显高于对照组(P <0.001)。结果说明人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣瓣环扩张伴发心房颤动在围手术期安全有效。