| Objective:To divide 80 patients with valvular heart disease accompanied with atrial fibrillation in the Affiliated Hospital of Youjiang Medical College for Nationalities into two groups,Then the patients in the two groups were treated with Cardiac valve replacement,Cox-Maze Ⅳ radiofrequency ablation at the same time and simple Cardiac valve replacement.To observe the early postoperative clinical efficacy of two groups of patients,and to analyze whether patients with valvular heart disease accompanied with atrial fibrillation should be treated with Cox-Maze Ⅳ radiofrequency ablation at the same time of Cardiac valve replacement.Methods:1.Clinical data:Select from January 2018 to December 2020,40 patients with valvular heart disease accompanied with atrial fibrillation underwent cardiac valve replacement and Cox-Maze Ⅳ radiofrequency ablation or simple cardiac valve replacement in the Department of cardiothoracic vascular surgery,Affiliated Hospital of Youjiang Medical College for Nationalities.1.1 Inclusion criteria and exclusion criteria:(1)Inclusion criteria:(1)The diagnosis of mitral and/or aortic valve disease was clear,which met the indications of valve replacement;(2)Patients with mitral and/or aortic valve disease accompanied with atrial fibrillation;(3)Preoperative NYHA classification,gender,age and weight were comparable(P>0.05).(2)Exclusion criteria:(1)Rheumatic activity was not controlled or controlled for less than 3 months;(2)Heart failure accompanied with myocardial ischemia damage;(3)The patients with bacterial endocarditis had septicemia and multiple infections;(4)The liver and kidney function or general condition is too poor to be operated on;(5)Large left atrium(diameter of left atrium≥65 mm).2.Grouping:(1)From January 2018 to August 2019,40 patients diagnosed with valvular heart disease accompanied with atrial fibrillation underwent cardiac valve replacement as control group;(2)From September 2019 to December 2020,40 patients diagnosed with valvular heart disease accompanied with atrial fibrillation underwent cardiac valve replacement and Cox-Maze Ⅳ radiofrequency ablation at the same time were selected as the observation group.Since the Department of cardiothoracic vascular surgery of the Affiliated Hospital of Youjiang Medical College for Nationalities started cardiac valve replacement in September2019 and underwent Cox-Maze Ⅳ radiofrequency ablation at the same time,the patients in the observation group were all surgical patients in September 2019 and after,and the patients in the control group were all surgical patients in August 2019 and before.3.Observation index(1)The time of cardiopulmonary bypass and aortic occlusion,the indwelling time of Pericardial and mediastinal drainage tubes and the use of ventilator,and the perioperative hospital stay were compared;(2)The conversion rate of sinus rhythm on the first day after operation and the maintenance of sinus rhythm on discharge and one month after discharge;(3)Left ventricular diameter and left ventricular ejection fraction before and 1month after operation;(4)the incidence of complications of heart valve replacement,such as perivalvular leakage,low cardiac output syndrome,acute respiratory failure,liver insufficiency and liver failure.4.Statistical methodsThis study used spss20.0 statistical software for statistical analysis,only when the data conform to the normal distribution can we use the following methods:measurement data is expressed by means±standard deviation(x±s),using t test;count data is expressed by frequency,using(?)~2test.According to the test level ofα=0.05,when p>0.05,there may be no significant difference between the two groups.When p<0.05,there was significant difference between the two groups.Results:1.There were significant differences in the cardiopulmonary bypass time and aortic clamping time between the observation group and the control group(P<0.05).The cardiopulmonary bypass time and aortic clamping time in the observation group were longer than those in the control group.2.There was no significant difference between the observation group and the control group in the use time of postoperative ventilator,the indwelling time of postoperative mediastinum and pericardial drainage tube and the perioperative hospital stay(P>0.05).It can not be considered that the use time of postoperative ventilator,the indwelling time of postoperative mediastinum and pericardial drainage tube and the perioperative hospital stay of the observation group and the control group are different.3.In the observation group and the control group after 1 day of sinus rhythm conversion rate,discharge and postoperative 1 month of sinus rhythm maintenance rate comparison,the differences were statistically significant(P<0.05),the observation group after 1 day of sinus rhythm conversion rate,discharge and postoperative 1 month of sinus rhythm conversion rate were higher than the control group.4.There was no significant difference in NYHA classification of preoperative cardiac function between the observation group and the control group(P>0.05).The NYHA classification of postoperative cardiac function in the observation group was better than that in the control group(P<0.05).5.There was no significant difference in left ventricular diameter between the two groups before operation(P>0.05).The left ventricular diameter of the observation group and the control group were compared after operation,and the difference was statistically significant(P<0.05).The left ventricular diameter of the control group was larger than that of the observation group one month after operation.6.There was no significant difference in left ventricular ejection fraction between the two groups before operation(P>0.05).After operation,the left ventricular ejection fraction of the observation group and the control group was compared,and the difference was statistically significant(P<0.05).The left ventricular ejection fraction of the control group was less than that of the observation group.7.There was no significant difference between the observation group and the control group in the incidence of complications of cardiac valve replacement,such as perivalvular leakage,low cardiac output syndrome,acute respiratory failure,liver insufficiency and liver failure,The difference was not statistically significant(P<0.05).Conclusion:1.This study shows that Cox-Maze Ⅳ radiofrequency ablation during cardiac valve replacement does not increase the incidence of complications of cardiac valve replacement,nor does it have a negative impact on the postoperative rehabilitation of patients.2.This study found that Cox-Maze Ⅳ radiofrequency ablation in patients with valvular heart disease accompanied with atrial fibrillation can significantly improve the early sinus rhythm conversion rate and sinus rhythm maintenance rate and ventricular remodeling and left ventricular ejection fraction and NYHA classification of cardiac function compared with cardiac valve replacement alone. |
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