迷宫-3手术联合心脏干预后心房收缩性和重构的评价

G. N. Antipov, A. S. Postol, S. Kotov, M. Makarova, Y. Schneider
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摘要

高光。房颤手术治疗最重要的目标是消除心律失常,恢复心房收缩力,改善心房转运功能。我们的研究显示,在正常心律恢复的背景下,迷宫-3手术后心房收缩和重构的积极动态。窦性心律预测指标的研究将有助于对患者进行个性化的选择。评价迷宫-3手术后心房收缩和重构与心脏综合干预措施。对217例联合手术干预进行了分析,其中使用maze-3治疗心房颤动(AF)。该手术于2012年至2016年在我中心进行。研究重点:术后心律和超声心动图控制在长期随访中,以确定心房收缩力和容积的动态。平均随访时间为47(1 ~ 100)个月。阵发性房颤40例(18.4%),持续性房颤38例(17.5%),长期持续性房颤139例(64.1%)。房颤术前平均病程27.4个月(1 ~ 200个月)。迷宫-3手术的适应症是:抗心律失常治疗无效,需要进行联合心脏手术。我们采用标准的统计研究方法,采用单因素和多因素logistic回归。在长期随访中,79%的患者存在窦性心律(SR)。在长期随访中,本组患者左房收缩力由76%恢复至91%,双房收缩力由82%恢复至96%。术前房颤持续时间较短是SR恢复和心房收缩力的积极预测因子(p = 0.005),而肺动脉压和患者年龄对这些指标有负面影响(p = 0.041和p = 0.038)。术后早期出现SR并不是房颤自由的显著预测因子。同时,根据长期观察,保持正常心房心率的患者心房收缩功能恢复阳性指标和心房容积减小的积极动态。复律和恢复左心房收缩性是迷宫手术的两个相互关联的目标。与房颤手术治疗失败相关的负面因素有肺动脉压力升高、术前房颤长期存在以及患者的年龄。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of atrial contractility and remodeling after the Maze-3 procedure with combined heart interventions
Highlights. The most important goal of atrial fibrillation surgical treatment is to eliminate the arrhythmia in order to restore atrial contractility and improve their transport function. Our study showed positive dynamics of atrial contractility and remodeling after the maze-3 procedure against the background of a regular heart rhythm restoration. The study of sinus rhythm predictors maintenance and recovery of atrial transport function will help to make patient selection more personified.Aim. Evaluation of atrial contractility and remodeling after the maze-3 procedure with combined interventions on the heart.Methods. The analysis of 217 combined surgical interventions was carried out, where a maze-3 was used to treat atrial fibrillation (AF). The operations were performed in our center from 2012 to 2016. Key points of the study: rhythm after surgery and echocardiographic control in the long-term follow-up in order to determine the dynamics of atrial contractility and volumes. The average follow-up period was 47 (1–100) months. 40 (18.4%) patients had paroxysmal, 38 (17.5%) persistent, 139 (64.1%) long-term persistent AF. The mean AF duration before surgery was 27.4 months (1–200 months). The indications for the maze-3 procedure were: ineffectiveness of antiarrhythmic therapy, the need to perform combined cardiac procedures. We used standard statistical research methods with one – and multivariate logistic regression.Results. In the long-term follow-up, sinus rhythm (SR) persists in 79% of patients. In the long-term follow-up, in this group of patients, the left atrial contractility was  restored  from  76%  to  91%,  while  the  biatrial  contractility  increased from 82 to 96%. Shorter AF duration before surgery was a positive predictor of SR recovery and atrial contractility (p = 0.005), while pulmonary artery pressure and patient age negatively affected these indicators (p = 0.041 and p = 0.038, respectively). The presence of SR early after surgery was not a significant predictor of AF freedom. At the same time, according to the long-term observations, patients maintaining a regular atrial heart rate had positive indicators of atrial systolic function restoration and a positive dynamics of a decrease in atrial volumes.Conclusion. SR and restoration of left atrial contractility are two interrelated goals of the maze procedure. The negative factors associated with the failure of surgical treatment of AF are increased pressure in the pulmonary artery, long-term AF before surgery, and the age of patients.
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