Goette Julia, Weimar Timo, Vosseler Martina, Raab Michael, Walle Ulrike, Czesla Markus, Doll Nicolas
Sana Cardiac Surgery, Stuttgart, Germany.
Heart Center Passau, Passau, Germany.
Thorac Cardiovasc Surg. 2016 Dec;64(8):672-678. doi: 10.1055/s-0035-1563537. Epub 2015 Sep 4.
Recent guidelines have recommended the addition of ablation in cardiac surgery for patients presenting with atrial fibrillation (AF). Currently available cryoablation devices use either nitrous oxide or argon gas as cooling agent. Our study aimed to compare success rates of two different devices currently available on the market and applied during concomitant cardiac surgery. Between 2009 and 2012, data were collected from 120 consecutive patients in whom either the aluminum cryoICE ablation probe (AtriCure, Inc., Cincinnati, Ohio, United States) using nitrous oxide or the stainless steel Cardioblate CryoFlexTM 10-S probe (Medtronic, Inc., Minneapolis, Minnesota, United States) using argon gas was applied for concomitant ablation procedures in minimally invasive mitral valve cases. Perioperative variables, myocardial injury biomarkers (MIBs) and Holter monitoring results were compared. Perioperative variables such as sex, age, type, and duration of AF, procedure and cross-clamp times, and 30-day mortality did not significantly differ between the groups. Postoperative peak creatinine kinase MB (CK-MB) levels were significantly higher in the nitrous oxide group ( = 0.047). At a mean follow-up of 20 ± 13 months, freedom from AF was significantly higher in the nitrous oxide group (87%) compared with the argon group (71%, = 0.044). Left atrial (LA) diameter and device used were the only predictors of failure of ablation ( = 0.029 and = 0.018, respectively). The nitrous oxide-based aluminum probe revealed a better outcome than the argon-based stainless steel probe. Besides the cooling agent, probe material and probe-tissue interface might have contributed to the better performance of the cryoICE probe.
近期指南建议，对于患有心房颤动（AF）的患者，在心脏手术中增加消融治疗。目前可用的冷冻消融设备使用一氧化二氮或氩气作为冷却剂。我们的研究旨在比较目前市场上两种不同设备在同期心脏手术中的成功率。2009年至2012年期间，收集了120例连续患者的数据，这些患者在微创二尖瓣手术的同期消融过程中，分别使用了使用一氧化二氮的铝制cryoICE消融探头（美国俄亥俄州辛辛那提市AtriCure公司）或使用氩气的不锈钢Cardioblate CryoFlexTM 10-S探头（美国明尼苏达州明尼阿波利斯市美敦力公司）。比较了围手术期变量、心肌损伤生物标志物（MIBs）和动态心电图监测结果。两组间的围手术期变量，如性别、年龄、房颤类型和持续时间、手术及阻断时间以及30天死亡率，差异均无统计学意义。一氧化二氮组术后肌酸激酶同工酶MB（CK-MB）峰值水平显著更高（P = 0.047）。平均随访20±13个月时，一氧化二氮组的房颤复发率显著低于氩气组（87%对71%，P = 0.044）。左心房（LA）直径和所用设备是消融失败的唯一预测因素（分别为P = 0.029和P = 0.018）。基于一氧化二氮的铝制探头显示出比基于氩气的不锈钢探头更好的结果。除了冷却剂外，探头材料和探头与组织的界面可能也有助于cryoICE探头表现更优。
