同期心房颤动射频消融对主动脉瓣膜置换手术风险的影响

摘要

Objective To investigate the effects of concomitant atrial fibrillation radiofrequency ablation (RFA) on surgical risk of aortic valve replacement (AVR).Methods A total of 496 consecutive patients with AVR from January 2005 to July 2015 were selected,among them 28 underwent underwent AVR and RFA,468 patients underwent single AVR.After matching with with propensity score matching methods by 1 ∶ 3,28 patients were enrolled in AVR + RFA group and 84 patients were enrolled in AVR group.All procedures were performed under general anesthsia and cardiopulmonary bypass.Patients in AVR + RFA group underwent concomitant left atrial or biatrial RFA during AVR,however,patients in AVR group only underwent valve relacement.The durations of cardiopulmonary bypass,aortic clamp,mechanical ventilation,intensive care unit (ICU) stay and hospital stay after operation,the perioperative adverse events were compared between the two groups.Results The durations of cardiopulmonary bypass and aortic clamp in AVR + RFA group were significantly longer than those in AVR group [(93 ±61) min vs (59 ±45) min,(65 ±40) min vs (40 ±30) min] (P ＜0.05).However,there were no significant differences in durations of mechanical ventilation,ICU stay and hospital stay after operation between groups [14 (5,18) h vs 8 (4,18) h,17 (8,32) h vs 16 (6,21) h,(7.0 ±2.4) d vs (7.5 ±3.0) d] (all P＞0.05).No stroke,dialysis for renal failure,death and readmission occurred within 30 days after operation in both groups;the incidences of perioperative adverse reactions were not significantly different between groups [ventilator assisted time ＞ 24 h:10.7％ (3/28) vs 6.0％ (5/84),opening stanching:3.6％ (1/28)vsO.0％ (0/84)] (P＞0.05).Conclusion Concomitant RFAduring AVR does not increase the surgical risk and has good safety.%目的 评价同期心房颤动射频消融对主动脉瓣膜置换(AVR)手术风险的影响.方法 选取2005年1月至2015年7月首都医科大学附属北京安贞医院心脏外科连续收治的496例AVR患者,其中AVR同期心房颤动射频消融28例,单纯AVR 468例.用倾向性评分按1∶3进行匹配,匹配后AVR+射频消融组28例,AVR组84例.手术均在全身麻醉体外循环下进行,AVR+射频消融组在AVR同期行左心房或双心房射频消融,而AVR组单纯行瓣膜置换.比较2组患者术中体外循环时间、升主动脉阻断时间、呼吸机辅助呼吸时间、重症监护病房滞留时间、术后住院时间和围术期不良反应发生情况.结果 AVR+射频消融组体外循环时间和升主动脉阻断时间明显长于AVR组[(93±61)min比(59±45) min、(65±40) min比(40±30) min],差异有统计学意义(P＜0.05).但2组呼吸机辅助呼吸时间、重症监护病房滞留时间、术后住院时间比较[14(5,18)h比8(4,18)h、17(8,32)h比16(6,21)h、(7.0±2.4)d比(7.5±3.0)d],差异无统计学意义(P＞0.05).2组患者术后均无脑卒中和肾功能衰竭透析,术后30 d无再次入院和死亡,2组围术期不良反应发生率比较[呼吸机辅助时间＞ 24 h:10.7％ (3/28)比6.0％ (5/84),因出血开胸止血:3.6％ (1/28)比0.0％ (0/84)],差异无统计学意义(P＞0.05).结论 AVR同期行心房颤动射频消融不增加围术期死亡及其他不良事件风险,具有良好的安全性.