Effect of pulmonary hypertension on clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study
- VernacularTitle:肺动脉高压对 Cox 迷宫 Ⅳ 手术治疗心脏瓣膜病合并心房颤动临床疗效影响的回顾性队列研究
- Author:
Wei LI
1
;
Chengxin ZHANG
1
;
Shenglin GE
1
;
Ran LI
1
;
Wenhui GONG
1
;
Tao CHEN
1
Author Information
1. Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, P.R.China
- Publication Type:Journal Article
- Keywords:
Atrial fibrillation;
Maze operation;
heart valve disease;
surgery
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2021;28(12):1432-1435
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease. Methods The clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hg in all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed. Results (1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)]. Conclusion PAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.
