Ren C L, Jiang S L, Xiao C S, Wang R, Gao C Q
Department of Cardiovascular Surgery, Institute of Cardiac Surgery of PLA, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2017 Apr 25;97(16):1227-1230. doi: 10.3760/cma.j.issn.0376-2491.2017.16.009.
To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (=10) and dual chamber pacemaker (=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery. All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up. For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.
总结心外膜永久起搏器植入与心脏手术一期手术的结果及临床应用经验。2014年11月至2016年7月，15例（男9例，女6例）年龄50至73（63.5±6.2）岁、因心动过缓需要心脏手术的患者接受了心外膜永久起搏器植入与心脏手术一期手术。所有手术均在全身麻醉下采用胸部正中切口入路进行。其中，植入单腔起搏器（=10）和双腔起搏器（=5）的心外膜永久起搏导线。同期手术包括瓣膜置换7例，瓣膜置换联合房颤消融3例，冠状动脉搭桥术2例，主动脉根部置换2例，瓣膜置换联合冠状动脉搭桥术1例。术中测量起搏器参数包括灵敏度、起搏阈值、起搏阻抗，并在术后1周及3、6个月进行密切随访。同期行心脏手术的心外膜永久起搏器植入的15例患者均治愈出院，无任何手术并发症。共为他们植入20根心外膜电极，其中右心房电极5根，右心室电极15根。术后随访时间为3至22个月。这些患者未发生电极断裂及手术切口感染，随访期间其阻抗、感知及刺激阈值均在正常范围内。对于需要心脏手术的心动过缓患者，心外膜永久起搏器植入与心脏手术一期手术安全有效，近期及中期效果满意，避免了分期手术的风险。
