| Objective:Surgical treatment of moderate and severe valvular diseases can effectively correct the hemodynamic disorders caused by cardiac organic lesions and improve cardiac function.The elimination of atrial fibrillation by surgical maze surgery can further reduce the risk of stroke,improve the quality of life and improve the long-term prognosis.However,valvular atrial fibrillation is usually accompanied by a long history and obvious left atrial enlargement,which are independent risk factors for postoperative atrial fibrillation recurrence,which greatly affect the effect of maze surgery.Some scholars try to use left atrial volume reduction surgery to reduce left atrial volume and relieve left atrial diastolic pressure at the same time of valve replacement and maze surgery,so as to promote the recovery of left ventricular function and reduce the recurrence of postoperative atrial fibrillation.However,this operation has the disadvantages of great trauma,high difficulty in operation and less clinical application,and there is still a lack of sufficient demonstration on its effect and safety.In this project,the perioperative and short-term follow-up indexes of valvular atrial fibrillation patients of left atrial enlargement at the hospital with and without left atrial volume reduction surgery were retrospectively analyzed and compared to try to demonstrate the efficacy and safety of valve replacement plus maze type Ⅳ surgery for left atrial volume reduction at the same time.The statistical results of our center contribute to the development of this field and add a practical and reliable theoretical basis for the clinical decision-making of this kind of patients.At the same time,the deficiencies reflected also provide a warning for colleagues,with a view to further improvement.Method:The clinical data of 50 patients with valvular heart disease complicated with atrial fibrillation and left atrial diameter>60mm treated in our hospital from June 2017 to September 2019 were analyzed retrospectively.25 patients with membrane replacement plus maze Ⅳ surgery were included in the control group,and 25 patients with valve replacement plus maze Ⅳ surgery plus left atrial volume reduction were included in the volume reduction group.The perioperative indexes such as ascending aortic occlusion time,CPB time,mechanically assisted ventilation time,24-hour drainage,vasoactive drug score(VIS)at the same day,day 1,day 2 and day 3 after operation,ICU stay and hospital stay were compared between the two groups;the occurrence rate of secondary thoracotomy to stop bleeding,severe conduction block,pneumonia and other complications and death;and the recurrence rate of atrial fibrillation at discharge,3 months after operation and 1 year after operation.Cardiac ultrasound indexes such as LAD,LAVI,LVEF,LVEDD,cardiothoracic ratio and NYHA cardiac function classification were measured before and 1 year after operation,and the scores of physical function BF,physiological function RP,energy status TV and health status GH were scored in the brief scale of SF-36 health survey before and 1 year after operation.Result:There was no significant statistical difference in preoperative general condition and medical history between the two groups,and there was no significant difference in the type of valve operation between the two groups(P>0.05).The aortic cross-clamping time,CPB time and VIS on the same day/1 day/2 days after operation in the volume reduction group were significantly higher than those in the control group(P<0.05).However,the time of mechanical ventilation in the volume reduction group was significantly lower than that in the control group(P<0.05).There was no significant difference in postoperative 24-hour drainage,ICU stay time,hospital stay and VIS on the 3rd day after operation(P>0.05).There was no significant difference in the incidence of postoperative complications and mortality between the two groups(P>0.05).At the time of discharge and 3 months after operation,the recurrence rate of atrial fibrillation in the volume reduction group was lower than that in the control group(P>0.05),but the recurrence rate of atrial fibrillation in the volume reduction group was significantly lower than that in the control group 1 year after operation(P<0.05).One year after operation,the cardiac function grade of LVEF and NYHA in the volume reduction group was higher than that in the control group,while the levels of LAD,LAVI,LVEDD and cardiothoracic ratio in the volume reduction group were significantly lower than those in the control group(P<0.05).One year after operation,the four scores of SF-36 in the volume reduction group were significantly higher than those in the control group(P<0.05).Conclusion:Patients with valvular atrial fibrillation with left atrium>60mm were treated with valve replacement plus maze type Ⅳ surgery plus left atrial volume reduction,which increased the ascending main occlusion time,CPB duration and vasoactive drug maintenance dose 48 hours after operation.However,it did not increase the incidence of perioperative complications and mortality,but shorted the time of mechanical ventilation,reduced the recurrence rate of atrial fibrillation,and promoted the recovery of cardiac function and the improvement of quality of life one year after operation. |
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