Ishii Yosuke, Sakamoto Shun-Ichiro, Miyagi Yasuo, Kawase Yasuhiro, Otsuka Toshiaki, Nitta Takashi
Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Semin Thorac Cardiovasc Surg. 2018;30(3):271-278. doi: 10.1053/j.semtcvs.2018.01.004. Epub 2018 Feb 2.
The purpose of this study was to determine the 22-year experience of the relationship between preoperative left atrial diameter (LAD) and atrial fibrillation (AF) recurrence after AF surgery. Between November 1993 and April 2015, 244 patients underwent AF surgery concomitant with mitral valve surgery, and were completely followed up in our institute. The full-maze procedure was performed in 231 patients and pulmonary vein isolation in 13. Three quartiles divided the list of sorted LAD data into 4 groups: group Q1: LAD = 40.5 ± 4.3 (n = 55), group Q2: LAD = 47.9 ± 2.0 (n = 61), group Q3: LAD = 54.2 ± 1.6 (n = 66), and group Q4: LAD = 64.2 ± 5.6 (n = 62). The AF cure rates for 22 years were verified between the groups. Although the AF cure rate of the full-maze procedure was 94%, 80%, 63%, and 51% at 1, 5, 10, and 20 years after AF surgery, respectively, it was 100% at 5 and 10 years after the pulmonary vein isolation (P = 0.088). Although there were no significant differences in the AF cure rate between groups Q1-Q3, the AF cure rate was significantly lower in group Q4 than the other groups (P < 0.001). A multivariate Cox proportional hazard model revealed that the preoperative LAD and cardiothoracic ratio were significant risk factors of AF recurrence (hazard ratio 1.063 per 1-mm increase, P = 0.003, and hazard ratio 1.064 per 1% increase, P = 0.043, respectively). AF surgery was effective for 22 years after surgery for AF concomitant with mitral valve disease. A preoperative LAD of ≥58.0 mm and the cardiothoracic ratio were risk factors of AF recurrence after AF surgery.
本研究的目的是确定术前左心房直径（LAD）与房颤（AF）手术后房颤复发之间的22年关系。1993年11月至2015年4月期间，244例患者在接受二尖瓣手术的同时接受了房颤手术，并在我院进行了完整的随访。231例患者接受了全迷宫手术，13例接受了肺静脉隔离术。将排序后的LAD数据列表按四分位数分为4组：Q1组：LAD = 40.5±4.3（n = 55），Q2组：LAD = 47.9±2.0（n = 61），Q3组：LAD = 54.2±1.6（n = 66），Q4组：LAD = 64.2±5.6（n = 62）。对各组之间22年的房颤治愈率进行了验证。虽然全迷宫手术在房颤手术后1、5、10和20年的房颤治愈率分别为94%、80%、63%和51%，但肺静脉隔离术后5年和10年的治愈率为100%（P = 0.088）。虽然Q1-Q3组之间的房颤治愈率无显著差异，但Q4组的房颤治愈率显著低于其他组（P < 0.001）。多变量Cox比例风险模型显示，术前LAD和心胸比是房颤复发的显著风险因素（每增加1毫米的风险比为1.063，P = 0.003；每增加1%的风险比为1.064，P = 0.043）。房颤合并二尖瓣疾病手术后，房颤手术在术后22年是有效的。术前LAD≥58.0毫米和心胸比是房颤手术后房颤复发的风险因素。
