瓣膜置换联合射频消融和左心耳闭合术治疗心脏瓣膜病并发房颤患者的临床效果

doi:10.13481/j.1671-587x.20200630

Abstract

Abstract: Objective

To study the changes of cardiac function indexes， changes of related factors levels in blood and complications such as cerebral infarction in the patients with valvular disease complicated with atrial fibrillation after valve replacement combined with radiofrequency ablation and left atrial appendage closure.

Methods

The clinical data of 128 patients were retrospectively analyzed and the patients were divided into two groups according to the patient’s operation types： mitral valve replacement combined with radiofrequency ablation and left atrial appendage closure treatment group （combined surgery group） and mitral valve replacement treatment group.The sinus rhythm restoration rates， cardiac function indexes， complications， levels of interleukin-1β （IL-1β）， interleukin-6（IL-6）， and tumor necrosis factor-α（TNF-α） and homocysteine in blood of the patients in two groups were detected， and the prognosis was evaluated.

Results

Compared with mitral valve replacement treatment group， the sinus rhythm restoration rates of the patients in combined surgery group in the end of surgery， three months， six months and one year after surgery were increased （P<0.01）. There were no significant differences in the preoperative cardiac function indexes of the patients between mitral value replacement treatment group and combined surgery group （P>0.05）. One year after surgery，compared with mitral value replacement treatment group， the left atrial diameter （LAD） and left ventricular end-diastolic diameter （LVEDD） of the patients in combined surgery group were decreased（P<0.05）， the ejection fraction （EF） was increased（P<0.05），the incidence rates of complications were deceased （P<0.05）， and the levels of IL-1β， IL-6， TNF-α， and homocysteine in blood of the patients were significantly decreased（P<0.01）.

Conclusion

Valvular replacement combined with radiofrequency ablation and left atrial appendage closure in the treatment of patients with valvular disease complicated with atrial fibrillation has good effect，and it can improve the cardiac function of patients， decrease the levels of inflammatory cytokines and homocysteine， reduce the incidence of cerebral infarction and bleeding， and improve the life quality of patients.

Key words: valve replacement, radiofrequency ablation, left atrial appendage closure, inflammatory cytokines, homocysteine, stroke

CLC Number:

R542.5

Yulei WEI,Yuhuan CUI,Bo HAN,Dawei WANG,Guigang WANG,Qian LI,Wen ZENG. Clinical effect of valve replacement combined with radiofrequency ablation and left atrial appendage closure in treatment of valvular heart disease complicated with atrial fibrillation[J].Journal of Jilin University(Medicine Edition), 2020, 46(6): 1298-1303.

Figures/Tables 6

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References 26

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Group	n	Gender		Age（year）	LAD (l/mm)	LVEDD (l/mm)	EF (η/%)	Cardiac function grade Ⅲ	Cardiac function grade Ⅳ
Group	n	Female	Male	Age（year）	LAD (l/mm)	LVEDD (l/mm)	EF (η/%)	Cardiac function grade Ⅲ	Cardiac function grade Ⅳ
Mitral valve replacement treatment	68	26	42	59.8±9.1	51.3±7.2	58.0±6.5	51.2±4.0	46	22
Combined surgery	60	22	38	60.1±8.4	52.2±7.7	58.6±6.4	50.7±3.6	42	18
t/χ ²		0.033		0.176	0.734	0.710	0.509	0.082	0.082
P		0.855		0.861	0.465	0.612	0.479	0.774	0.774

Group	n	Sinus rhythm conversion rate
Group	n	End of operation	3 months	6 months	One year
Mitral valve replacement treatment	68	16.2(11/68)	8.8 (6/68)	10.3 (7/68)	8.8(6/68)
Combined surgery	60	83.3 (50/60)	71.6 (43/60)	73.3 (44/60)	75.0 (45/60)
χ²		57.630	53.280	52.848	58.239
P		<0.01	<0.01	<0.01	<0.01

Group	n	LAD(l/mm)		LVEDD(l/mm)		EF(η/%)
Group	n	Before operation	1 year after operation	Before operation	1 year after operation	Before operation	1 year after operation
Mitral valve replacement treatment	68	51.3±7.2	45.4±5.6	58.0±6.5	51.7±4.2	51.2±4.0	55.5±3.0
Combined surgery	60	52.2±7.7	42.9±5.2	58.6±6.4	53.2±4.1	50.7±3.6	56.9±3.1
t		0.734	2.579	0.509	2.012	0.710	2.448
P		0.465	0.011	0.612	0.046	0.479	0.016

Group	n	Bleeding	Cerebral infarction
Mitral valve replacement treatment	68	17.5(12/68)	8.1(6/68)
Combined surgery	60	4.5(3/60)	0(0/60)
χ²		4.928	5.554
P		0.026	0.018

Group	n	IL-1β		IL-6		TNF-α
Group	n	Before operation	1 year after operation	Before operation	1 year after operation	Before operation	1 year after operation
Mitral valve replacement treatment	68	84.5±14.1	62.0±17.4	90.0±31.9	55.1±13.1	47.9±17.0	32.3±10.2
Combined surgery	60	83.2±16.0	29.8±6.5	98.4±43.4	34.4±6.3	45.4±16.0	14.6±5.8
t		0.504	13.524	1.252	11.190	0.853	11.765
P		0.615	0.000	0.213	0.000	0.395	0.000

Clinical effect of valve replacement combined with radiofrequency ablation and left atrial appendage closure in treatment of valvular heart disease complicated with atrial fibrillation

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