Xu Zheng, Xiang Haiyan, Wang Jiwei, Liu Chen, Tang Yanhua, Yang Juesheng
Department of Cardiovascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330008, China.
Department of Ultrasonography, the Second Affiliated Hospital of Nanchang University, Nanchang 330008, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Mar 25;54(2):250-256. doi: 10.3724/zdxbyxb-2024-0636.
To analyze the efficacy and safety of concomitant left atrial appendage clipping during heart valve surgery for valvular heart disease patients with atrial fibrillation.
Fifty-eight patients who underwent concomitant left atrial appendage clipping during cardiac valve surgery in the Second Affiliated Hospital of Nanchang University from January 2017 to June 2023 were included in the analysis, including 1 case who underwent aortic valve replacement, 49 cases who underwent mitral valve replace-ment (or valvuloplasty)+tricuspid valvuloplasty, and 8 cases who underwent double valve replacement+tricuspid valvuloplasty (3 cases combined with coronary artery bypass grafting). The patients were followed up for 3-36 months [(16.69±6.61) months] after operation, and the changes of cardiac function and the occurrence of serious adverse complications were evaluated.
The cardiopulmonary bypass time ranged from 75 to 145 min [(102.50±21.03) min], and the aortic cross-clamp time ranged from 35 to 80 min [(58.02±14.63) min]. The length of postoperative intensive care unit stay was 1 to 5 days [(2.47±0.82) d], and the length of postoperative hospital stay was 7 to 22 days [(10.84±2.69) d]. Cardiac ultrasound indicated complete closure of the left atrial appendage in all cases. During the follow-up, New York Heart Association (NYHA) functional classifications were improved in 54 patients. No left atrial appendage-related bleeding events or other perioperative complications were observed; and no cerebral infarction, limb embolism events, or mortality cases occurred during the follow-up.
For valvular heart disease patients with atrial fibrillation, concomitant left atrial appendage clipping during cardiac valve surgery demonstrates efficacy and safety, with no severe adverse events during a medium-term follow-up.
分析心脏瓣膜手术同期行左心耳夹闭术治疗合并心房颤动的瓣膜性心脏病患者的疗效及安全性。
纳入2017年1月至2023年6月在南昌大学第二附属医院行心脏瓣膜手术同期行左心耳夹闭术的58例患者，其中行主动脉瓣置换术1例，二尖瓣置换术（或成形术）+三尖瓣成形术49例，双瓣置换术+三尖瓣成形术8例（3例合并冠状动脉搭桥术）。术后随访3~36个月[（16.69±6.61）个月]，评估心功能变化及严重不良并发症的发生情况。
体外循环时间75145分钟[（102.50±21.03）分钟]，主动脉阻断时间3580分钟[（58.02±14.63）分钟]。术后重症监护病房停留时间15天[（2.47±0.82）天]，术后住院时间722天[（10.84±2.69）天]。心脏超声显示所有病例左心耳完全闭合。随访期间，54例患者纽约心脏病协会（NYHA）心功能分级改善。未观察到左心耳相关出血事件或其他围手术期并发症；随访期间未发生脑梗死、肢体栓塞事件及死亡病例。
对于合并心房颤动的瓣膜性心脏病患者，心脏瓣膜手术同期行左心耳夹闭术疗效及安全性良好，中期随访无严重不良事件发生。
