Pyo WonKyung, Park Sung Jun, Kim Wan Kee, Kim Ho Jin, Kim Joon Bum, Jung Sung-Ho, Joo Suk Jung, Chung Cheol Hyun, Lee Jae Won
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2019 Apr;52(2):61-69. doi: 10.5090/kjtcs.2019.52.2.61. Epub 2019 Apr 5.
Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement.
From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes.
During 49.1 months of follow-up (interquartile range, 22.5-96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02-1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22-7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00-1.05; p=0.045) were significantly associated with AF recurrence.
The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.
关于生物瓣膜置换术患者同期进行房颤消融的疗效，报道的数据较少。
对2001年至2014年期间连续146例（年龄69.3±9.4岁，女性84例）接受生物心脏瓣膜置换术同期房颤消融的患者进行评估。我们评估了长期节律和瓣膜相关结局。
在49.1个月的随访期间（四分位间距为22.5 - 96.8个月），发生7例住院死亡和49例（每人年6.7%）出院后死亡。5年时无血栓栓塞事件生存率为79.2%±3.5%。5年时房颤无复发率为59.8%±4.9%。多因素分析显示，高龄（风险比[HR]，1.06；95%置信区间[CI]，1.02 - 1.11；p = 0.002）、既往心脏手术史（HR，3.01；95% CI，1.22 - 7.43；p = 0.02）和左心房（LA）内径增大（HR，1.02；95% CI，1.00 - 1.05；p = 0.045）与房颤复发显著相关。
这些主要为老年患者同期进行房颤消融和生物瓣膜置换术的总体长期临床结局令人满意；然而，房颤复发较为常见。高龄、既往心脏手术史和LA增大与房颤复发风险增加相关。
