Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2012 Dec;94(6):1894-9; discussion 1900. doi: 10.1016/j.athoracsur.2012.07.040. Epub 2012 Sep 7.
With improving surgical care yielding better outcomes, patients who have undergone a cardiac operation are surviving longer, and surgeons will inevitably face an increasing number of reoperative procedures. There are few data reporting risk and outcome for patients undergoing atrial fibrillation ablation in this clinical setting.
From January 1994 through May 2009, we performed surgery for AF in 245 patients (134 female) who have had at least1 prior cardiac operation. Median age was 45 years (range 1 to 75 years) and preoperative atrial fibrillation was paroxysmal in 161 patients (66%). Most common cardiac diagnoses included Ebstein anomaly (n=43), tetralogy of Fallot (n=36), and acquired valvular or ischemic heart disease (n=35). Median prior sternotomies was 1 (range 1 to 6).
Ablative lesions most commonly included isolated right-sided maze (n=123; cryothermy in 84, cut and sew in 39), biatrial maze (n=52; cryothermy in 26, cut and sew in 26), and right atrial isthmus ablation (n=41; isolated in 30, concomitant in 11). There were 14 early deaths (5.7%). New permanent pacemaker was required in 39 patients (18%); indication was complete heart block in 9. Rhythm at late follow-up (median: 4.1 years, maximum: 17.2 years) was 89% in the setting of congenital heart disease and 78% in acquired heart disease.
Atrial fibrillation is common with a variety of pathologies requiring redo cardiac surgery. Lesion set and energy source are dependent on primary procedure. Concomitant AF ablation during redo cardiac reoperations can be performed with reasonable safety and success.
随着外科手术水平的提高带来了更好的治疗效果，接受过心脏手术的患者存活时间更长，外科医生将不可避免地面临越来越多的再次手术。目前，关于在这种临床情况下接受房颤消融术的患者的风险和结果的数据很少。
从 1994 年 1 月至 2009 年 5 月，我们对 245 名（134 名女性）至少进行过 1 次心脏手术的房颤患者进行了手术治疗。中位年龄为 45 岁（范围 1 至 75 岁），术前房颤为阵发性的患者有 161 名（66%）。最常见的心脏诊断包括埃布斯坦畸形（n=43）、法洛四联症（n=36）和获得性瓣膜或缺血性心脏病（n=35）。中位既往胸骨切开术为 1 次（范围 1 至 6 次）。
消融性病变最常见的包括孤立的右侧迷宫（n=123；冷冻治疗 84 例，切割和缝合 39 例）、双侧迷宫（n=52；冷冻治疗 26 例，切割和缝合 26 例）和右房峡部消融（n=41；孤立性 30 例，同时性 11 例）。早期死亡 14 例（5.7%）。需要植入 39 例（18%）新的永久性起搏器；9 例为完全性心脏阻滞。在先天性心脏病患者中，晚期随访（中位时间：4.1 年，最长时间：17.2 年）的节律为 89%，在获得性心脏病患者中为 78%。
在需要再次心脏手术的各种病变中，房颤很常见。病变集和能源来源取决于初次手术。在再次心脏手术中同时进行房颤消融可以安全且成功地进行。
