Park Won Kyoun, Lee Jae Won, Kim Joon Bum, Jung Sung-Ho, Choo Suk Jung, Chung Cheol Hyun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
Korean J Thorac Cardiovasc Surg. 2012 Feb;45(1):11-8. doi: 10.5090/kjtcs.2012.45.1.11. Epub 2012 Feb 7.
The aim of this study is to evaluate the clinical and rhythm outcomes of atrial fibrillation (AF) ablation through a port access approach compared with sternotomy in patients with AF associated with mitral valve diseases.
From February 2006 through December 2009, 135 patients underwent biatrial AF ablation with a mitral operation via either a port-access approach (n=78, minimally invasive cardiac surgery [MICS] group) or a conventional sternotomy (n=57, sternotomy group). To adjust for the differences in the two groups' baseline characteristics, a propensity score analysis was performed.
After adjustment, there were no significant differences in the two groups' baseline profiles. The cardiopulmonary bypass time was significantly longer (p=0.045) in the MICS group (176.0±49.5 minutes) than the sternotomy group (150.0±51.9 minutes). There were no significant differences (p=0.31) in the two groups' rate of reoperation for bleeding (MICS=6 vs. sternotomy= 2, p=0.47) or the requirement for permanent pacing (MICS=1 vs. sternotomy=3). The major event-free survival rates at two years were 87.4±8.1% in the MICS group and 89.6±5.8% in the sternotomy group (p=0.92). Freedom from late AF at 2 years was 86.8±6.2% in the MICS group and 85.0±6.9% in the sternotomy group (p=0.86).
Both the port-access approach and sternotomy showed tolerable clinical outcomes following biatrial AF ablation with mitral valve surgery.
本研究旨在评估与二尖瓣疾病相关的心房颤动（房颤）患者，经端口入路与胸骨切开术行房颤消融术的临床及节律转归。
2006年2月至2009年12月，135例患者通过端口入路（n = 78，微创心脏手术[MICS]组）或传统胸骨切开术（n = 57，胸骨切开术组）行二尖瓣手术同期双房房颤消融术。为校正两组基线特征的差异，进行了倾向评分分析。
校正后，两组基线资料无显著差异。MICS组（176.0±49.5分钟）的体外循环时间显著长于胸骨切开术组（150.0±51.9分钟）（p = 0.045）。两组再次手术止血率（MICS组=6例 vs. 胸骨切开术组=2例，p = 0.47）或永久起搏需求（MICS组=1例 vs. 胸骨切开术组=3例）无显著差异（p = 0.31）。MICS组两年时主要无事件生存率为87.4±8.1%，胸骨切开术组为89.6±5.8%（p = 0.92）。MICS组两年时无晚期房颤发生率为86.8±6.2%，胸骨切开术组为85.0±6.9%（p = 0.86）。
二尖瓣手术同期双房房颤消融术后，端口入路和胸骨切开术均显示出可耐受的临床转归。
