従来の心動脈外科手術と鼓動性心動脈外科手術後の心房細動の予測要因:前向きなランダム化研究

R Ascione¹, M Caputo, G Calori

¹Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.

Circulation

|September 27, 2000

まとめ

心筋梗塞による心肺バイパス (CPB) は,冠動脈バイパス移植 (CABG) の後の術後の心房細動 (AF) のリスクを大幅に高めます. 鼓動する心臓のオフポンプ手術はAFの発生を減少させます.

科学分野:

心臓病学心臓病学
心臓外科手術について
クリニック・リサーチ臨床研究

背景:

動脈動 (AF) は,冠動脈バイパス移植 (CABG) の後の一般的な合併症であり,患者の罹病率を増加させます.
CABG後のAFの正確な原因は完全に理解されていませんし,現在の予防戦略は不十分です.

研究の目的:

術後のAFの発生における心肺バイパス (CPB) と心筋麻痺停止の役割を調査する.
オンポンプ対オフポンプCABGを受ける患者におけるAFの発生率を比較する.

主な方法:

CABGを受ける200人の患者を対象とした予見的なランダム化研究.
患者は,CPBと心臓麻痺の停止を伴うポンプ上の従来の手術,または鼓動する心臓のポンプ外手術のいずれかに割り当てられました.
手術後のAFは,自動リズム不良検出およびその後の臨床観察を使用して72時間間モニタリングされました.

主要な成果:

100人のオンポンプ患者のうち39人が継続的な術後のAFを発症したが,オフポンプ患者の100人中8人しか発症しなかった (P=0.001).
単一分析では,心筋梗塞の停止,イノトロプ的サポート,挿管時間,胸部感染症,入院をAFの予測要因としてCPBを特定しました.
多変量回帰分析は,心筋梗塞を伴うCPBを,手術後のAFの唯一の独立した予測因子として確認した (OR 7.4).

結論:

心筋梗塞を伴う心肺バイパス (CPB) は,冠動脈再循環手術を受けている患者の術後の心房細動の主要な独立リスク因子です.
オフポンプCABGは,手術後のAFの発生率を減らすための戦略かもしれません.

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