经右胸微创二尖瓣置换同期双心房射频消融术的临床分析

目的总结对二尖瓣置换同期双心房射频消融患者实施右侧微创手术的优点及疗效。方法纳入2009月10月至2012年10月中国医科大学附属第一医院收治的二尖瓣病变合并心房颤动（房颤）患者8例,男4例、女4例,年龄34~67（52.4±17.5）岁。经右胸微创切口行二尖瓣置换同期双心房射频消融术,观察其疗效。结果全部患者无院内死亡,无术中转常规手术切口病例。置换生物瓣2例,机械瓣6例。手术时间（207.9±18.1）min,体外循环时间（81.7±23.9）min,胸腔引流量（126.7±34.5）ml。术后第3 d房颤心律1例,出院时均为窦性心律。随访时间（18.3±7.4）个月,房颤复发1例,心功能分级（NYHA）Ⅰ级7例,Ⅱ级1例。结论经右胸微创二尖瓣置换同期双心房射频消融术可以同时保证治疗效果并美容,值得在二尖瓣病变合并房颤手术中推广。

Minimally lnvasive Mitral Valve Replacement Combined with Atrial Fibrillation Radiofrequency Ablation via Right Minithoracotomy

Objective To summarize clinical advantages and outcomes of minimally invasive mitral valve replacement （MVR） combined with atrial fibrillation （AF） radiofrequency ablation via right minithoracotomy. Methods Eight patients with mitral valve disease and AF who received surgical therapy in the First Hospital of China Medical University between October 2009 and October 2012 were included in the study. There were 4 males and 4 females with their age of 34-67 （ 52.4 ±17.5 ） years. All the patients underwent minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy. Clinical outcomes were summarized. Results There was no in-hospital death or conversion to conventional sternotomy in this group. Two patients received biological valve replacement and 6 patients received mechanical prosthesis. Operation time was 207.9 ±18.1 minutes, cardiopulmonary bypass time was 81.7 ±23.9 minutes, and chest drainage amount was 126.7±34.5 ml. AF recurred in 1 patient on the 3rd postoperative day. All the patients were in sinus rhythm at discharge. These patients were followed up for 18.3 ± 7.4 months. During follow-up, 1 patient had AF recurrence. Seven patients were in NYHA class I, and 1 patients was in NYHA class II . Conclusion Minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy can achieve satisfactory clinical results and esthetic appearance, and is a good choice for patients with mitral valve disease and AF.