Yochun Jung, Kyo Seon Lee, Sang Gi Oh, Byoung Hee Ahn
{"title":"迷宫手术联合心房内膜切除术治疗左心房钙化的远期疗效。","authors":"Yochun Jung, Kyo Seon Lee, Sang Gi Oh, Byoung Hee Ahn","doi":"10.5761/atcs.oa.23-00013","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Left atrial calcification (LAC) is found in long-lasting rheumatic valvular disease and is almost always accompanied by atrial fibrillation (AF). In the presence of LAC, endoatriectomy is required when performing the maze procedure. However, the technical feasibility of endoatriectomy and the long-term outcomes of the maze procedure in patients with LAC are uncertain.</p><p><strong>Methods: </strong>The medical records of 18 consecutive patients who underwent combined endoatriectomy and maze procedure were analyzed retrospectively.</p><p><strong>Results: </strong>Accompanying operations were mitral valve replacement (n = 16) and commissurotomy (n = 2). There was 1 operative death from sepsis following mediastinitis. When patients were divided into \"broad\" (n = 11) and \"limited\" (n = 7) groups, with the extent of LAC either greater or less than half of the left atrium, respectively, there was no intergroup difference in postoperative complications. During follow-up (median, 11.4 years), AF recurred in 11 patients. At the last follow-up visits, electrocardiography revealed significantly fewer patients in the broad group maintaining sinus rhythm (1/11 vs 4/6, P = 0.03). The 10-year AF recurrence-free survival rates were 13.9% and 66.7% in the broad and limited groups, respectively (P = 0.01).</p><p><strong>Conclusions: </strong>The maze procedure combined with endoatriectomy seems technically feasible with acceptable long-term rhythm outcomes if the LAC extent is limited.</p>","PeriodicalId":8037,"journal":{"name":"Annals of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/14/atcs-29-141.PMC10284664.pdf","citationCount":"0","resultStr":"{\"title\":\"Long-Term Outcomes of the Maze Procedure Combined with Endoatriectomy for Patients with Calcified Left Atria.\",\"authors\":\"Yochun Jung, Kyo Seon Lee, Sang Gi Oh, Byoung Hee Ahn\",\"doi\":\"10.5761/atcs.oa.23-00013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Left atrial calcification (LAC) is found in long-lasting rheumatic valvular disease and is almost always accompanied by atrial fibrillation (AF). In the presence of LAC, endoatriectomy is required when performing the maze procedure. However, the technical feasibility of endoatriectomy and the long-term outcomes of the maze procedure in patients with LAC are uncertain.</p><p><strong>Methods: </strong>The medical records of 18 consecutive patients who underwent combined endoatriectomy and maze procedure were analyzed retrospectively.</p><p><strong>Results: </strong>Accompanying operations were mitral valve replacement (n = 16) and commissurotomy (n = 2). There was 1 operative death from sepsis following mediastinitis. When patients were divided into \\\"broad\\\" (n = 11) and \\\"limited\\\" (n = 7) groups, with the extent of LAC either greater or less than half of the left atrium, respectively, there was no intergroup difference in postoperative complications. During follow-up (median, 11.4 years), AF recurred in 11 patients. At the last follow-up visits, electrocardiography revealed significantly fewer patients in the broad group maintaining sinus rhythm (1/11 vs 4/6, P = 0.03). The 10-year AF recurrence-free survival rates were 13.9% and 66.7% in the broad and limited groups, respectively (P = 0.01).</p><p><strong>Conclusions: </strong>The maze procedure combined with endoatriectomy seems technically feasible with acceptable long-term rhythm outcomes if the LAC extent is limited.</p>\",\"PeriodicalId\":8037,\"journal\":{\"name\":\"Annals of Thoracic and Cardiovascular Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2023-06-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/14/atcs-29-141.PMC10284664.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5761/atcs.oa.23-00013\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5761/atcs.oa.23-00013","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的:左房钙化(LAC)常见于长期风湿性心瓣膜病,且几乎总是伴有心房颤动(AF)。在LAC存在的情况下,在进行迷宫手术时需要进行子宫内膜切除术。然而,技术可行性和迷宫手术对LAC患者的长期预后尚不确定。方法:回顾性分析18例连续行腔内切除联合迷宫手术患者的病历。结果:伴有二尖瓣置换术(n = 16)和合气道切开术(n = 2)。有1例患者因纵隔炎后脓毒症手术死亡。将患者分为“宽”组(n = 11)和“窄”组(n = 7),分别根据LAC的程度大于或小于左心房的一半,两组间术后并发症无差异。在随访期间(中位11.4年),11例患者房颤复发。在最后一次随访时,心电图显示广泛组维持窦性心律的患者明显减少(1/11 vs 4/6, P = 0.03)。广泛组和有限组10年无复发生存率分别为13.9%和66.7% (P = 0.01)。结论:如果LAC程度有限,迷宫手术联合腔内切除术在技术上似乎是可行的,并且具有可接受的长期节律结果。
Long-Term Outcomes of the Maze Procedure Combined with Endoatriectomy for Patients with Calcified Left Atria.
Purpose: Left atrial calcification (LAC) is found in long-lasting rheumatic valvular disease and is almost always accompanied by atrial fibrillation (AF). In the presence of LAC, endoatriectomy is required when performing the maze procedure. However, the technical feasibility of endoatriectomy and the long-term outcomes of the maze procedure in patients with LAC are uncertain.
Methods: The medical records of 18 consecutive patients who underwent combined endoatriectomy and maze procedure were analyzed retrospectively.
Results: Accompanying operations were mitral valve replacement (n = 16) and commissurotomy (n = 2). There was 1 operative death from sepsis following mediastinitis. When patients were divided into "broad" (n = 11) and "limited" (n = 7) groups, with the extent of LAC either greater or less than half of the left atrium, respectively, there was no intergroup difference in postoperative complications. During follow-up (median, 11.4 years), AF recurred in 11 patients. At the last follow-up visits, electrocardiography revealed significantly fewer patients in the broad group maintaining sinus rhythm (1/11 vs 4/6, P = 0.03). The 10-year AF recurrence-free survival rates were 13.9% and 66.7% in the broad and limited groups, respectively (P = 0.01).
Conclusions: The maze procedure combined with endoatriectomy seems technically feasible with acceptable long-term rhythm outcomes if the LAC extent is limited.