二尖瓣机械瓣置换术中闭塞左心耳预防风湿性心房颤动患者脑栓塞的临床研究

Left atrial appendage occlusion during mitral valve replacement for prevention of cerebral embolism in patients with rheumatic atrial fibrillation

摘要:

目的  探讨在二尖瓣机械瓣置换术中采用丝线结扎闭塞左心耳的安全性，并评价其预防风湿性心房颤动（AF）患者脑栓塞的有效性。方法  2012年4月-2014年3月，258例风湿性AF患者在该院接受二尖瓣机械瓣置换术治疗，129例术中采用双十号丝线从心外结扎闭塞左心耳（结扎组），129例未行左心耳结扎术（对照组），通过观察两组手术相关指标、术后并发症以及随访期内脑栓塞发生率，并进行分析。结果  两组手术时间、体外循环时间、阻断时间、ICU入住时间、术后住院时间，以及术后再次开胸止血、低心排血量综合征、急性肾功能衰竭、肺部感染、胸骨切口裂开发生率比较，差异无统计学意义；结扎组死亡2例，而对照组死亡3例，差异无统计学意义。结扎组127例随访（23.6±11.3）个月，无一例发生脑栓塞，而对照组126例随访（22.9±12.1）个月，5例发生脑栓塞，差异有统计学意义（P <0.05）。结论  二尖瓣机械瓣置换术中采用丝线结扎闭塞左心耳，简单安全，可降低风湿性AF患者脑栓塞的发生率。

Abstract:

Objective To investigate the safety of left atrial appendage occlusion by silk thread ligation during mitral valve replacement in patients with rheumatic heart disease and atrial fibrillation, and to evaluate its effectiveness for prevention of cerebral embolism. Methods From April 2012 to March 2014, 129 patients with rheumatic heart disease and atrial fibrillation underwent mitral valve replacement and left atrial appendage occlusion by ligation using two silk threads from the outside of the heart (ligation group). The control group included 129 patients without ligation of left atrial appendage over the same period. The indexes related to the operation, and the incidence of postoperative complications and cerebral embolism during the follow-up period were compared between the two groups. Results There was no significant difference in the operation time, cardiopulmonary bypass time, clamp time, Intensive Care Unit stay time or the postoperative hospitalization time between both groups. There was no significant difference in the mortality rate or the incidence of postoperative complications including thoracotomy for hemostasis, low cardiac output syndrome, acute renal failure, pulmonary infection and sternal wound dehiscence between the two groups. No cerebral embolism occurred in the ligation group during the follow-up of (23.6 ± 11.3) months in all the 127 patients, but 5 patients suffered from cerebral embolism in the control group during the follow-up of (22.9 ± 12.1) months in 126 patients, the difference was significant between the two groups (P < 0.05). Conclusions Left atrial appendage occlusion by silk thread ligation during mitral valve replacement is simple and safe for patients with rheumatic heart disease and atrial fibrillation, and can reduce the incidence of cerebral embolism.