Albåge Anders, Vanky Farkas, Boano Gabriella, Holmgren Anders, Jidéus Lena, Johansson Birgitta, Kennebäck Göran, Nozohoor Shahab, Scherstén Henrik, Sjögren Johan, Wickbom Anders, Ivert Torbjörn
Department of Cardiothoracic Surgery and Anesthesiology, University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 3;39(6). doi: 10.1093/icvts/ivae189.
Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure.
In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022.
There were 4 deaths within 30 days (1.0%). Mean follow-up was 8.7 (0.1-13.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic stroke, of which 4 were fatal. Five of 34 patients (14.7%) with a history of stroke preoperatively experienced ischaemic stroke during follow-up. The linearized rate of ischaemic stroke per patient-year was 0.6% and was similar regardless of left atrial appendage closure during surgery or whether a mechanical valve was inserted. The observed ischaemic stroke rate was lower than the predicted rate for all CHA2DS2-VASc score groups. Fourteen patients suffered cerebral bleeding, of which 3 were fatal. Patients who experienced cerebral bleeding were older and had higher mechanical valve implantation rate than those without cerebral bleeding.
Surgery for mitral valve insufficiency and concomitant Cox-maze IV can be performed with low perioperative risk. There is a low continuing risk of stroke long-term postoperatively that correlates with a higher CHA2DS2-VASc score. Patients with preoperative stroke are at increased risk of postoperative stroke despite atrial fibrillation surgery.
分析二尖瓣手术及同期Cox迷宫IV手术治疗的房颤患者发生缺血性卒中和脑出血的长期风险。
2009年至2017年期间，瑞典共有397例有症状的退行性二尖瓣关闭不全合并房颤患者接受了二尖瓣手术及Cox迷宫IV手术。在这项全国性回顾性分析中，通过国家患者登记系统对患者进行随访，直至2022年9月30日。
30天内有4例死亡（1.0%）。平均随访时间为8.7（0.1 - 13.4）年。5年和10年无缺血性卒中和脑出血的生存率分别为90%和74%。19例患者发生缺血性卒中，其中4例死亡。术前有卒中史的34例患者中有5例（14.7%）在随访期间发生缺血性卒中。每位患者每年缺血性卒中的线性发生率为0.6%，无论手术期间是否关闭左心耳或是否植入机械瓣膜，该发生率均相似。观察到的缺血性卒中发生率低于所有CHA2DS2-VASc评分组的预测发生率。14例患者发生脑出血，其中3例死亡。发生脑出血的患者比未发生脑出血的患者年龄更大，机械瓣膜植入率更高。
二尖瓣关闭不全手术及同期Cox迷宫IV手术可在低围手术期风险下进行。术后长期卒中持续风险较低，且与较高的CHA2DS2-VASc评分相关。尽管接受了房颤手术，但术前有卒中的患者术后发生卒中的风险增加。
