Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan.
Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2024 Nov;72(11):703-709. doi: 10.1007/s11748-024-02027-9. Epub 2024 Apr 12.
Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied.
The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients.
There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3 years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8 months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded.
The surgical procedures for AF are safe and effective in cases requiring emergency surgery.
最近外科设备的发展，包括左心耳封堵术，使外科医生能够对房颤（AF）进行积极的手术治疗。然而，紧急情况下房颤手术的结果尚未得到广泛研究。
本研究旨在探讨与心血管事件相关的紧急手术情况下房颤手术的疗效。我们纳入了 18 例因急症行各种类型房颤手术的患者，包括急性主动脉夹层（n=6）、急性心肌梗死（n=5）、射频导管消融穿孔引起的出血（n=4）、急性二尖瓣反流（n=2）和心脏肿瘤（n=1）。4 例和 10 例患者分别接受了全迷宫手术和肺静脉隔离术。3 例患者还进行了神经节丛消融的联合手术。4 例患者仅行左心耳闭合术。
在我们的患者系列中，没有手术死亡或主要不良心脏和脑血管事件。AF 或房性心动过速无复发的 1 年和 3 年的比率分别为 92.9%和 82.5%。在平均 46.7±25.8 个月的随访期间，患者未发生血栓栓塞事件。此外，无心血管死亡记录。
在需要紧急手术的情况下，AF 的外科手术是安全有效的。
