Kang Yoonjin, Choi Jae Woong, Kim Ji Seong, Sohn Suk Ho, Hwang Ho Young, Kim Kyung Hwan
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Thorac Dis. 2023 May 30;15(5):2475-2484. doi: 10.21037/jtd-22-1018. Epub 2023 Apr 3.
This study evaluated the outcome of surgical ablation (SA) for atrial fibrillation (AF) concomitant with redo left-sided valvular surgery.
The study enrolled 224 AF patients (paroxysmal: 13 patients, persistent: 76 patients, long-standing persistent AF: 135 patients) undergoing redo open heart surgery for left-sided valve disease. The early results and long-term clinical outcomes were compared between those who underwent concomitant SA for AF (SA group) and did not (NSA group). Propensity score adjusted Cox regression analysis of overall survival and competing risk analysis of the other clinical outcomes were performed.
Seventy-three patients were classified as the SA group and 151 as the NSA group. The median follow-up duration was 124 (1.0-249.5) months. The median ages of the patients in the SA and NSA groups were 54.1±11.3 and 58.4±11.1 years, respectively. There were no significant differences between the groups in the early in-hospital mortality rate (5.5% 9.3%, P=0.474) or postoperative complications, except for low cardiac output syndrome (11.0% 23.8%, P=0.036). Overall survival was better in the SA group [hazard ratio, 0.452; 95% confidence interval (CI): 0.218-0.936, P=0.032]. The incidence of recurrent AF was significantly higher in the SA group on multivariate analysis [hazard ratio, 3.440; 95% CI: 1.987-5.950, P<0.001]. The cumulative incidence of the composite of thromboembolism and bleeding was lower in the SA than NSA group [hazard ratio, 0.338; 95% CI: 0.127-0.897, P=0.029].
The concomitant surgical arrhythmia ablation with redo cardiac surgery for left-sided heart disease resulted in a better overall survival, higher incidence of sinus conversion, and lower incidence of a composite of thromboembolism and major bleeding. Concomitant SA procedure should be considered in patients undergoing redo cardiac surgery.
本研究评估了房颤（AF）合并再次左侧瓣膜手术时外科消融（SA）的疗效。
本研究纳入了224例因左侧瓣膜疾病接受再次心脏直视手术的房颤患者（阵发性：13例，持续性：76例，长期持续性房颤：135例）。比较了接受房颤合并SA治疗的患者（SA组）和未接受该治疗的患者（非SA组）的早期结果和长期临床结局。进行了倾向评分调整的Cox回归分析以评估总生存率，并对其他临床结局进行了竞争风险分析。
73例患者被分类为SA组，151例为非SA组。中位随访时间为124（1.0 - 249.5）个月。SA组和非SA组患者的中位年龄分别为54.1±11.3岁和58.4±11.1岁。除低心排血量综合征外（11.0%对23.8%，P = 0.036），两组在早期院内死亡率（5.5%对9.3%，P = 0.474）或术后并发症方面无显著差异。SA组的总生存率更好[风险比，0.452；95%置信区间（CI）：0.218 - 0.936，P = 0.032]。多因素分析显示SA组房颤复发率显著更高[风险比，3.440；95% CI：1.987 - 5.950，P < 0.001]。SA组血栓栓塞和出血复合事件的累积发生率低于非SA组[风险比，0.338；95% CI：0.127 - 0.897，P = 0.029]。
对于左侧心脏病患者，再次心脏手术同时进行外科心律失常消融可带来更好的总生存率、更高的窦性心律转复率以及更低的血栓栓塞和大出血复合事件发生率。对于接受再次心脏手术的患者，应考虑同时进行SA手术。
