Right minithoracotomy versus conventional median sternotomy for patients undergoing mitral valve surgery and Cox-maze IV ablation with entirely bipolar radiofrequency clamp
Right minithoracotomy versus conventional median sternotomy for patients undergoing mitral valve surgery and Cox-maze IV ablation with entirely bipolar radiofrequency clamp
复制标题
右小胸廓切开术与传统正中胸骨切开术治疗接受二尖瓣手术和完全双极射频钳 Cox-maze IV 消融的患者
DOI：
10.1007/s00380-018-1126-4
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发表时间：
2018-08-01
影响因子：
1.5
通讯作者：
Mei, Ju
中科院分区：
文献类型：
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作者：
Jiang, Zhaolei;Tang, Min;Mei, Ju
认为双极射频钳的Cox-maze IV消融仅通过正中胸骨切开术（MS）进行，但不可能通过右侧小切口（RM）进行。现在，我们开发了一种新的技术，完全通过双极钳通过RM进行Cox迷宫IV消融。比较RM或MS用于接受二尖瓣手术并伴随使用完全双极钳的Cox-maze IV消融的患者的结局。分析了所有152例接受二尖瓣外科手术的患者，并分析了通过RM（n = 69）或MS（n = 83）使用双极钳夹进行的Cox-maze IV消融术的结局差异。二尖瓣疾病的病因为风湿性（n = 97）和退行性（n = 55）。所有患者均存在长期持续性房颤（AF）。左心房直径42 ~ 60 mm。所有患者均成功完成双极钳下的Cox-maze IV消融。RM组的体外循环时间（130.3 +/- 17.7 vs 115.3 +/- 14.4 min; P < 0.001）和主动脉阻断时间（91.8 +/- 12.7 vs 74.6 +/- 9.3 min; P < 0.001）较长。但RM组的机械通气时间（14.2 ± 6.6 vs 21.3 ± 9.0 h; P < 0.001）和住院时间（9.3 ± 2.6 vs 11.7 ± 3.0 d; P < 0.001）较短。出院时，RM组和MS组的正常窦性心律（NSR）维持率分别为94.2%和95.1%（P = 1.000）。术后2年NSR的累积维持率RM组为85.1 +/- 5.8%，MS组为88.6 +/- 3.6%（P = 0.767）。对于接受二尖瓣外科手术并同时进行Cox-maze IV消融（采用完全双极钳夹）的患者，RM可达到与MS相似的治疗效果。此外，通过RM的患者恢复更快。
Cox-maze IV ablation by bipolar radiofrequency clamp was considered to be only performed through median sternotomy (MS), but impossible through right minithoracotomy (RM). Now, we developed a novel technique of performing Cox-maze IV ablation entirely by bipolar clamp through RM. To compare the outcomes of RM or MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. All 152 patients underwent mitral valve surgery and concomitant Cox-maze IV ablation with bipolar clamp through RM (n = 69) or MS (n = 83) were analyzed for outcome differences. The etiology of mitral valve disease was rheumatic (n = 97) and degenerative (n = 55). All patients had long-standing persistent atrial fibrillation (AF). Diameter of left atrium ranged from 42 to 60 mm. All patients successfully underwent Cox-maze IV ablation by bipolar clamp. RM group had longer cardiopulmonary bypass time (130.3 +/- 17.7 vs 115.3 +/- 14.4 min; P < 0.001) and aortic cross-clamp time (91.8 +/- 12.7 vs 74.6 +/- 9.3 min; P < 0.001). But mechanical ventilation time (14.2 +/- 6.6 vs 21.3 +/- 9.0 h; P < 0.001) and hospital length of stay (9.3 +/- 2.6 vs 11.7 +/- 3.0 days; P < 0.001) were shorter in RM group. At discharge, the maintenance of normal sinus rhythm (NSR) was 94.2% in RM group and 95.1% in MS group (P = 1.000). Cumulative maintenance of NSR at 2 years postoperatively was 85.1 +/- 5.8% in RM group and 88.6 +/- 3.6% in MS group (P = 0.767). RM can achieve similar therapeutic effect to MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. In addition, patients through RM had faster recovery.