UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Heart Rhythm. 2018 Apr;15(4):512-519. doi: 10.1016/j.hrthm.2017.11.009. Epub 2017 Nov 11.
There is limited experience of surgical epicardial access in the contemporary era of ventricular tachycardia ablation after cardiac surgery.
The purpose of this study was to describe our institutional experience with surgical epicardial access and the influence of surgical approach and compare outcomes with those of a propensity-matched percutaneous epicardial access control group.
We performed a retrospective study of consecutive surgical epicardial ventricular tachycardia (VT) ablation cases from a single center. Surgical cases were propensity-matched to percutaneous epicardial ablation controls and short-term and long-term outcomes were compared.
Between 2004 and 2016, 38 patients underwent 40 surgical epicardial access procedures (subxiphoid, n = 22; thoracotomy, n = 18). The commonest indication was prior coronary artery bypass grafting (45%), valve surgery (22%), or ventricular assist device (VAD) (10%). The mean procedure time was 444 minutes (standard deviation, 107 minutes). Mapped epicardial geometry area was 149 cm (interquartile range 182 cm), which comprised 36% of the mapped epicardial geometric area of a percutaneous control group. Subxiphoid access gave preferential access to the inferior and inferolateral left ventricular segments and was less frequently able to access the anterior, anterolateral, and apical segments compared with a thoracotomy approach. When compared with results from a propensity-matched percutaneous-access group, short-term outcomes, complication rates, and 1-year survival free from a combined end point of VT recurrence, death, or transplantation were not statistically different.
Surgical epicardial access after cardiac surgery for ablation of VT in patients with careful preprocedure evaluation can be performed with acceptable safety with no statistical difference in long-term outcomes compared with a propensity-matched percutaneous epicardial cohort. The region of left ventricular epicardium that can be mapped is limited compared with that of percutaneous cases and is determined by the surgical approach.
在心脏手术后行室性心动过速（VT）消融的当代时代，外科心外膜入路的经验有限。
本研究旨在描述我们机构在外科心外膜入路方面的经验，以及手术入路的影响，并与经皮心外膜入路的倾向性匹配对照组进行比较。
我们对单中心连续的外科心外膜 VT 消融病例进行了回顾性研究。将外科病例与经皮心外膜消融对照组进行倾向性匹配，并比较短期和长期结果。
2004 年至 2016 年，38 例患者接受了 40 例外科心外膜入路手术（剑突下，22 例；开胸，18 例）。最常见的适应证是既往冠状动脉旁路移植术（45%）、瓣膜手术（22%）或心室辅助装置（VAD）（10%）。平均手术时间为 444 分钟（标准差 107 分钟）。映射的心外膜几何面积为 149cm²（四分位距 182cm²），占经皮对照组映射的心外膜几何面积的 36%。剑突下心外膜入路优先进入左心室下壁和下外侧壁段，与开胸入路相比，进入前壁、前外侧壁和心尖段的频率较低。与倾向性匹配的经皮入路组相比，短期结果、并发症发生率以及 1 年无 VT 复发、死亡或移植的复合终点生存率无统计学差异。
在心脏手术后，对 VT 消融患者进行仔细的术前评估后，可安全进行外科心外膜入路，与倾向性匹配的经皮心外膜组相比，长期结果无统计学差异。与经皮病例相比，可映射的左心室心外膜区域有限，并且取决于手术入路。
