Reyhancan Adem, Öz Kürşad, Kafa Kulaçoğlu Ülkü, Ersoy Burak, Apaydın Zinar, Onan Burak
Department of Cardiovascular Surgery, Muş State Hospital, Muş, Turkey.
Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2022 Jan 28;30(1):36-43. doi: 10.5606/tgkdc.dergisi.2022.22611. eCollection 2022 Jan.
This study aims to investigate the effect of atriotomy approaches applied in mitral valve surgery and variations of the sinoatrial nodal artery on postoperative arrhythmias and the need for a temporary or permanent pacemaker.
Data of 241 patients (108 males, 133 females, mean age: 53.7±12.3 years; range, 18 to 82 years) who underwent isolated mitral valve surgery with a median sternotomy between January 2009 and December 2019 were retrospectively analyzed. The patients were divided into three groups according to the surgical approach for mitral valve exploration as left atriotomy (n=47), transseptal (n=131), and superior transseptal (n=63). By scanning the hospital records, the origin of the sinoatrial nodal artery was determined in the coronary angiography images obtained before surgery. Postoperative rhythm changes were analyzed based on electrocardiography and telemetry recordings.
Temporary pacing was required in 31 (49.2%) patients in the superior transseptal group, 40 (30.5%) patients in the transseptal group, and 12 (25.5%) patients in the left atriotomy group, indicating a statistically significantly higher rate in the superior transseptal group (p=0.013). Permanent pacemaker implantation was required in only one patient (superior transseptal), indicating no significant difference among the groups. The first-degree atrioventricular block was seen in 28 (44.4%) patients in the superior transseptal group, 42 (32.1%) patients in the transseptal group, and 13 (27.7%) patients in the left atriotomy group (p=0.130). The PR interval in the postoperative period was longer in the superior transseptal group than in the left atriotomy group in patients with the sinoatrial nodal artery originating from the right coronary artery (p=0.049). No significant difference was observed among the surgical approaches regarding the PR interval in patients with the sinoatrial nodal artery originating from the left circumflex coronary artery after surgery.
We believe that the choice of atriotomy in isolated mitral valve surgery and sinoatrial nodal artery variations do not affect permanent arrhythmia alone. Still, the superior transseptal approach causes the electrical conduction to slow down temporarily more than the left atriotomy and transseptal method.
本研究旨在探讨二尖瓣手术中采用的心房切开术方法及窦房结动脉变异对术后心律失常及临时或永久起搏器需求的影响。
回顾性分析2009年1月至2019年12月期间241例行正中胸骨切开术的单纯二尖瓣手术患者（男性108例，女性133例，平均年龄：53.7±12.3岁；范围18至82岁）的数据。根据二尖瓣探查的手术方式将患者分为三组：左心房切开术组（n = 47）、经房间隔组（n = 131）和上经房间隔组（n = 63）。通过查阅医院记录，在术前获得的冠状动脉造影图像中确定窦房结动脉的起源。根据心电图和遥测记录分析术后心律变化。
上经房间隔组31例（49.2%）患者、经房间隔组40例（30.5%）患者和左心房切开术组12例（25.5%）患者需要临时起搏，上经房间隔组的发生率在统计学上显著更高（p = 0.013）。仅1例患者（上经房间隔组）需要植入永久起搏器，表明各组之间无显著差异。上经房间隔组28例（44.4%）患者、经房间隔组42例（32.1%）患者和左心房切开术组13例（27.7%）患者出现一度房室传导阻滞（p = 0.130）。在窦房结动脉起源于右冠状动脉的患者中，上经房间隔组术后PR间期长于左心房切开术组（p = 0.049）。术后窦房结动脉起源于左旋支冠状动脉的患者，各手术方式在PR间期方面无显著差异。
我们认为，单纯二尖瓣手术中的心房切开术选择和窦房结动脉变异不会单独影响永久性心律失常。然而,上经房间隔入路比左心房切开术和经房间隔方法更易导致电传导暂时减慢。
