| Atrial fibrillation is a common arrhythmia in clinical practice and more than 30 million people suffer from atrial fibrillation worldwide.The majority of patients are usually complicated by other organic heart diseases,especially heart valve disease.With the development of medical technology and consolidation of the aging of population,incidence of rheumatic valvular disease have decreased,however,the number of patients with degenerative valvular disease is rising.The two types of heart valve disease have been the main etiology of atrial fibrillation.The patients with atrial fibrillation lose atrial function,resulting in reduced cardiac output and often have symptoms such as palpitation and fatigue.The long stagnation of blood in atrium led to thrombosis and embolism in brain and body.As a result,the patients had to receive long-term anticoagulation with a risk of bleeding if anticoagulant is excessive.Atrial fibrillation has brought a heavy burden to the patients and society because of complications and mortality.In terms of an important meaning,surgeons should treat the patients with atrial fibrillation as far as possible.Studies have shown that Cox-maze ? procedure has been accepted as the gold standard with a high efficiency in the treatment of atrial fibrillation.However,the procedure has not obtained widespread acceptance due to technically demanding procedure,prolonged CPB and more operation trauma.With the development of medical technology,the modified Cox-maze procedure which utilizes freezing ablation to replace the “cut-and-sew” technique has began to emerge gradually in the world,however,rarely reported in domestic.The study included two parts.Part one was about patients with atrial fibrillation concomitant heart valve disease.In this part,we summarized the perioperative treatment methods and analyzed what effect the etiology of heart valve disease,hypertension,and diabetes had on rate of sinus rhythm restoration in the treatment of atrial fibrillation.In part two,we compared the short-term results between Cox-maze procedure using cryoablation and Cox–maze ? procedure in the treatment of heart valve disease concomitant atrial fibrillation.Part 1 Objective: To summarize the experience of perioperative treatment of Cox-maze procedure using cryoablation for patients with atrial fibrillation concomitant valvular heart disease and to analyze whether the etiology of heart valve disease,hypertension,and diabetes have effect on rate of restoration of sinus rhythm.Methods: Clinical data of 65 patients who underwent Cox-maze procedure using cryoablation in our department between October 2015 and June 2017 were retrospectively analyzed.There were 24 male and 41 female patients with their age of 37 ~71(58.33±9.01)years.The AF duration was 0.5~240(48.86±47.46)months,and the left atrial diameter was 34 ~ 59(49.09±5.93)mm.Patients were assigned to two groups according to rhythm discharge.We compared the the etiology of heart valve disease and the morbidity of hypertension and diabetes in two groups,and analysed whether rheumatic valvular disease,hypertension and diabetes had effect on rate of restoration of sinus rhythm.Results: There was no perioperative death.The aortic-clamp time was 44 ~159(92.40±30.58)min,and the cardiopulmonary bypass time was 101 ~229(156.60±35.57)min.The bleeding volume was 200~600(340.00±76.38)ml.The assisted mechanical ventilator time was 15~48(23.29±11.22)h,and the ICU stay time was 16 ~ 96(41.57±31.41)h.7 patients(10.76 %)received cardioversion,and 27 patients(41.53 %)received temporary pacemaker implantation but no one required permanent pacemaker.At discharge,there were 42 patients(64.62%)in sinus rhythm,11 patients(16.92%)in atrial flutter rhythm,and 12 patients(18.46%)in atrial fibrillation rhythm.The etiology of heart valve disease,and the morbidity of hypertension and diabetes were similar in two groups(P>0.05).After multivariate logistic regression analysis,rheumatic valvular disease,hypertension and diabetes were not independent risk factors for sinus rhythm restoration.Conclusion: Rheumatic valvular disease,and hypertension,and diabetes have little effect on rate of restoration of sinus rhythm postoperative.Part 2 Objective: To compare the short-term results between Cox-maze procedure using cryoablation and Cox–maze ? procedure in the treatment of heart valve disease concomitant atrial fibrillation.Methods: Between December 2016 and June 2017,70 mitral valve disease patients with atrial fibrillation who underwent Cox-maze procedure using cryoablation or Cox–maze ? procedure were 1:1 matched and assigned to two groups.The clinical data,the cardiopulmonary bypass time,the ICU stay time,the complications,and the rate of restoration of sinus rhythm was compared.Results: There was no significant difference in age,gender,duration of atrial fibrillation perioperative complication between two groups(P>0.05).Compared with CM-cryo group,CM ? group had a longer aortic-clamp time(98.63±18.38 min vs 82.43±20.03 min,P < 0.001)and cardiopulmonary bypass time(192.90±28.02 min vs 156.60±26.96 min,P < 0.001).There was also no statistical difference in assisted mechanical ventilator time,and ICU stay time between two groups.4 patients received cardioversion in CM? group and 5 patients received cardioversion in CM-cryo group,without obvious difference(P=0.721).The two groups had similar rate of temporary pacemaker implantation(37.14 % vs 51.43 %,P=0.229).Complications such as atrial tachyarrhythmia,reoperation for bleeding,renal failure and so on were similar(P>0.05).Rate of restoration of sinus rhythm 1 month postoperative was higher in CM? group than that in CM-cryo group(94.28% vs 65.71%,P=0.003).Conclusion: Cox-maze procedure using cryoablation have a simplified procedure,and a shortened operative time,however,rate of restoration of sinus rhythm 1 month postoperative is lower compared with CM?. |
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