Department of Cardiac Surgery, Hospital de León, León, Spain.
J Cardiothorac Vasc Anesth. 2011 Dec;25(6):1030-5. doi: 10.1053/j.jvca.2011.06.011. Epub 2011 Aug 20.
Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications.
A prospective cohort study with cardiac surgical patients.
A tertiary care university hospital.
One hundred fifty-two cardiac surgical patients.
Patients underwent 1 of 2 different cryoablation approaches: the modified Cox-Maze (CM) III procedure (n = 63) or the isolated left atrial (LA) maze procedure (n = 89). Plasma levels of cardiac biomarkers were measured at 1, 6, 12, and 24 hours after surgery. Twenty-four-hour Holter monitoring was performed at 1 month and 1 year after surgery.
Both groups reached very high peak levels of CPK-MB (CM group, 368 ± 171.4 ng/mL and LA group, 203 ± 86.4 ng/mL) and troponin T (CM, 8 ± 4.5 ng/mL and LA, 3.4 ± 2.4 ng/mL). The CPK, CPK-MB, and troponin T levels were significantly higher in the modified CM group compared with the LA maze group. In the first 24 hours after surgery, the average CPK-MB and troponin T values were 78.2 ng/mL higher and 2.3 ng/mL higher, respectively, in the CM group compared with the LA group. In both groups, 79% of the patients remained free of AF at 12 months after surgery.
Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF.
心脏手术后无房颤（AF）消融术时心肌损伤标志物升高与围手术期心肌缺血有关，并与死亡率和心脏事件风险增加相关。然而，尚无研究检查 AF 冷冻消融术与心脏手术同时进行后心脏生物标志物的释放情况。作者确定了这两种不同程序的这些生物标志物的水平，并评估了它们的临床意义。
一项涉及心脏手术患者的前瞻性队列研究。
三级护理大学医院。
152 名心脏手术患者。
患者接受了 2 种不同冷冻消融方法之一：改良 Cox-Maze（CM）III 手术（n=63）或单独左心房（LA）迷宫手术（n=89）。在手术后 1、6、12 和 24 小时测量血浆中心脏生物标志物水平。手术后 1 个月和 1 年进行 24 小时 Holter 监测。
两组均达到非常高的 CPK-MB（CM 组，368±171.4ng/ml 和 LA 组，203±86.4ng/ml）和肌钙蛋白 T（CM，8±4.5ng/ml 和 LA，3.4±2.4ng/ml）峰值水平。改良 CM 组的 CPK、CPK-MB 和肌钙蛋白 T 水平明显高于 LA 迷宫组。手术后前 24 小时，CM 组的平均 CPK-MB 和肌钙蛋白 T 值分别比 LA 组高 78.2ng/ml 和 2.3ng/ml。在两组中，手术后 12 个月时，79%的患者仍无 AF。
心脏手术中的冷冻消融会导致释放出非常高水平的心肌损伤标志物。改良 CM 病变导致血清生物标志物水平升高幅度大于单独 LA 迷宫手术，但这种升高似乎对节律或总体结果没有不利影响。冷冻消融是一种安全有效的 AF 外科治疗方法。
