在大动脉和动脉瘤手术期间同时进行心房移除
Eric Robinson1, Tom Liu1, S Chris Malaisrie1
1Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Medicine Bluhm Cardiovascular Institute, Chicago, Ill.
JTCVS open
|September 9, 2025
概括
在大动脉动脉瘤和门手术期间进行心房动的外科切除是安全有效的. 它不会增加死亡率,并且与没有心房动的患者相比,导致相似的生存率和中风结果.
科学领域:
- 心血管外科心血管外科
- 心脏电生理学 心脏电生理学
- 大动脉外科手术
背景情况:
- 关于在上升大动脉动脉瘤和大动脉手术期间治疗心房动 (AF) 的数据有限.
- 在隔离性大动脉手术期间为AF进行手术切除具有I类指示.
- 这项研究评估了在上升性大动脉动脉瘤和大动脉手术期间同时进行AF切除的结果.
研究的目的:
- 确定与上升大动脉动脉瘤和大动脉手术同时进行的心房动手术的早期和晚期结果.
- 在这个患者群体中评估手术切除AF的安全性和有效性.
- 将结果与没有手术前AF的匹配队列进行比较.
主要方法:
- 分析了从2008年7月到2023年6月接受选择性上升大动脉动脉瘤 + 大动脉手术的患者队列.
- 患有和没有手术前AF同时接受AF切除的患者使用倾向性得分匹配进行了比较.
- 临床随访每年进行,平均为5.6年.
主要成果:
- 在792名患者中,有89人 (11.2%) 患有手术前的肌肉功能障碍,并接受了切除 (肺静脉隔离,左心房冷或双心房冷).
- 手术后的并发症,包括心脏起器植入物,新发性透析和30天死亡率,在匹配组之间是相似的 (没有AF与AF切除).
- 在接受同时手术的AF患者和没有AF患者之间,总体存活率和中风发病率在平均6.22年的随访期间是可比的.
结论:
- 对于心房的外科切除是有效和安全的,当与上升性大动脉动脉瘤和大动脉手术同时进行时.
- 同时的AF切除不增加30天死亡率,与没有AF的患者相比,产生类似的长期存活率和中风结果.
- 在接受上升性大动脉动脉瘤和大动脉门手术的患者中,应强烈考虑进行心房移除.
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