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

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

References 26

1	韩劲松，王辉山，汪曾炜，等. Cox迷宫Ⅲ型手术治疗风湿性二尖瓣病变伴发心房颤动的安全性和有效性［J］. 中华医学杂志， 2016， 96（13）： 1011-1015.
2	EMMERT M Y， PUIPPE G， BAUMÜLLER S， et al. Safe， effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery： first long-term results from a prospective device trial［J］. Eur J Cardiothorac Surg， 2014， 45（1）： 126-131.
3	CLEMENTY N， DESPRETS L， PIERRE B， et al. Outcomes after ablation for typical atrial flutter （from the Loire valley atrial fibrillation project）［J］. Am J Cardiol， 2014， 114（9）： 1361-1367.
4	张正升，韩贵芝，张申，等. 心脏瓣膜置换、房颤射频消融同期行左心耳结扎的疗效分析［J］. 实用医学杂志， 2019， 35（9）： 1438-1441.
5	杭永斌，李刚，王树伟，等. 心脏瓣膜置换术联合射频消融治疗心脏瓣膜病变的临床观察［J］.感染·炎症·修复， 2017， 18（2）： 98-102.
6	戎国祥，陈锁成，潘忠军. 瓣膜置换术中同期行双极射频消融治疗心房颤动的临床疗效［J］. 江苏医药， 2017， 43（14）： 1048-1049.
7	GILLINOV A M， GELIJNS A C， PARIDES M K， et al. Surgical ablation of atrial fibrillation during mitral-valve surgery［J］. N Engl J Med， 2015， 372（15）： 1399-1409.
8	糜烨东，张林飞，单立梅，等. 心脏瓣膜病手术同期射频消融治疗房颤的疗效分析［J］. 局解手术学杂志， 2017， 26（10）： 738-741.
9	LOARDI C， ALAMANNI F， GALLI C， et al. Surgical treatment of concomitant atrial fibrillation： focus onto atrial contractility［J］. Biomed Res Int， 2015， 2015： 274817.
10	王蒙，姜楠，徐栋，等. 瓣膜置换同期射频消融治疗房颤128例［J］. 中华胸心血管外科杂志， 2017， 33（2）： 107-108.
11	ABO-SALEM E， LOCKWOOD D， BOERSMA L， et al. Surgical treatment of atrial fibrillation［J］. J Cardiovasc Electrophysiol， 2015， 26（9）： 1027-1037.
12	李岑，张大国，龚启华，等. 心脏瓣膜置换同期行双极射频消融术治疗房颤的疗效及安全性探讨［J］. 贵州医药， 2013， 37（9）： 781-784.
13	GUO Y， LIP G Y， APOSTOLAKIS S. Inflammation in atrial fibrillation ［J］. J Am Coll Cardiol， 2012， 60 （22）： 2263-2270.
14	SATA N， HAMADA N， HORINOUCHI T， et al. C-reactive protein and atrial fibrillation. Is inflammation a consequence or a cause of atrial fibrillation？［J］. Jpn Heart J， 2004， 45（3）： 441-445.
15	ASSELBERGS F W， BERG M PVAN DEN， DIERCKS G F， et al. C-reactive protein and microalbuminuria are associated with atrial fibrillation［J］. Int J Cardiol， 2005， 98（1）： 73-77.
16	LI J， SOLUS J， CHEN Q X， et al. Role of inflammation and oxidative stress in atrial fibrillation［J］. Heart Rhythm， 2010， 7（4）： 438-444.
17	LAMBERTSEN K L， BIBER K， FINSEN B. Inflammatory cytokines in experimental and human stroke［J］. J Cereb Blood Flow Metab， 2012， 32（9）： 1677-1698.
18	ALLAN S M， TYRRELL P J， ROTHWELL N J. Interleukin-1 and neuronal injury［J］. Nat Rev Immunol， 2005， 5（8）： 629-640.
19	SIMI A， TSAKIRI N， WANG P， et al. Interleukin-1 and inflammatory neurodegeneration［J］. Biochem Soc Trans， 2007， 35（Pt 5）： 1122-1126.
20	MCCOY M K， TANSEY M G. TNF signaling inhibition in the CNS： implications for normal brain function and neurodegenerative disease［J］. J Neuroinflammation， 2008， 5： 45.
21	WHITELEY W， JACKSON C， LEWIS S， et al. Inflammatory markers and poor outcome after stroke： a prospective cohort study and systematic review of interleukin-6［J］. PLoS Med， 2009， 6（9）： e1000145.
22	LAZZERINI P E， CAPECCHI P L， MACCHERINI M， et al. Early and delayed increase in plasma homocysteine levels in heart transplanted patients［J］. Transplant Proc， 2002， 34（4）： 1275-1278.
23	ACAMPA M， LAZZERINI P E， GUIDERI F， et al. Ischemic stroke after heart transplantation［J］. J Stroke， 2016， 18（2）： 157-168.
24	YAO Y， SHANG M S， GAO L J， et al. Elevated homocysteine increases the risk of left atrial/left atrial appendage thrombus in non-valvular atrial fibrillation with low CHA2DS2-VASc score［J］. Europace， 2018， 20（7）： 1093-1098.
25	刘婷，汪小华，蒋文平. 东亚国家心房颤动华法林抗凝国际标准化比值范围是否有别于西方国家［J］. 中华心血管病杂志， 2016， 44（11）： 984-986.
26	刘媛，余细勇，钟诗龙，等. 心脏瓣膜置换术后华法林抗凝治疗的单中心临床应用调查［J］. 南方医科大学学报， 2010， 30（10）： 2242-2245.

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

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 26

Related Articles 15

Metrics

Comments

Recommended 10

[1]	Hao ZUO,Yao GAO,Zhonghan WANG,Youbo JI,Hui JIN. Percutaneous radiofrequency ablation of spinal nerve roots guided by ultrasound combined with CT thoracic neuralgia: A report of two cases and literature review [J]. Journal of Jilin University(Medicine Edition), 2026, 52(3): 813-820.
[2]	Jiulin YOU,Liangshu FENG,Xin LI,Xinyu WANG,Shuang WANG,Mingqin ZHU,Lingmin ZHAO,Xingqi SU,Jing WANG,Jiachun FENG,Chuan WANG,Di MA. Changes in serum cytokine levels, immune status and risk factor analysis in patients with acute ischemic stroke [J]. Journal of Jilin University(Medicine Edition), 2026, 52(2): 499-506.
[3]	Huiyan ZHU,Min CHEN,Jinxian LI,Chunli LI. Effect of enriched environment on neurofunctional damage in rats with ischemic stroke via transcription factor EB-mediated autophagy [J]. Journal of Jilin University(Medicine Edition), 2026, 52(1): 116-124.
[4]	Weiqi SUN,Lingyu ZHU,Xiaolei XU,Ying LIU,Hongmei LYU,Yahui LAI. Expressions of peripheral blood related biological markers in elderly patients with Alzheimer’s disease and intervention effect of selenium-rich food [J]. Journal of Jilin University(Medicine Edition), 2025, 51(5): 1333-1339.
[5]	Panxi SUN,Xue QIN,Chongyang ZHANG,Jia LUO,Yong CHEN,Lili WEI. Protective effect of TUG-891 on ischemic stroke induced by ischemia and hypoxia and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2025, 51(4): 968-975.
[6]	Dan ZHAO,Bo SHI,Zhixuan WEI,Qunjian CUI. Improvement effect of hirudin on post-stroke depression in mice and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2025, 51(3): 672-679.
[7]	Xingqi SU,Lingmin ZHAO,Di MA,Jiulin YOU,Ying CHEN,Liangshu FENG,Jing WANG,Jiachun FENG,Chuan WANG. Analysis on correlation of cerebral infarct area with cytokines and immune status in patients with acute ischemic stroke [J]. Journal of Jilin University(Medicine Edition), 2025, 51(1): 124-132.
[8]	Chaolong JIN,Xuegong SHI,Chengxin ZHANG,Youfeng LIANG,Jie XIAO,Zhe SHENG,Dingxin ZHANG. Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach [J]. Journal of Jilin University(Medicine Edition), 2025, 51(1): 228-237.
[9]	Dan ZHAO,Bo SHI,Zhixuan WEI,Qunjian CUI. Effect of nucleoredoxin in medial prefrontal cortex on depression-like behavior in mice with post-stroke depression and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2024, 50(6): 1606-1613.
[10]	Meng SUN,Ran ZHOU,Xinying ZHANG,Yaying CHENG. Late-onset methylmalonic acidaemia CblC type：Two case reports and literature review [J]. Journal of Jilin University(Medicine Edition), 2024, 50(5): 1420-1425.
[11]	Yawen LIAN,Yinghua LI,Guoxing XU,Xixi XIE,Zhenlan LI. Evaluation of recovery effect of finger motor dysfunction in patients with stroke after treated with force feedback perceptual rehabilitation training [J]. Journal of Jilin University(Medicine Edition), 2024, 50(4): 1116-1122.
[12]	Jing TANG,Huan LI,Shuo ZHANG,Ligang JING. Analysis on association between serum homocysteine and inflammatory response and oxidative stress in patients with acute ischemic stroke [J]. Journal of Jilin University(Medicine Edition), 2024, 50(3): 786-790.
[13]	Guanfei LI,Xunjuan ZHANG,Meng PANG,Song LI. Prospective study on association between hemodynamic patterns and risk of ischemic stroke in people with chronic orthostatic intolerance [J]. Journal of Jilin University(Medicine Edition), 2024, 50(2): 473-480.
[14]	Xiuling ZHOU,Deyu CONG,Ye ZHANG,Hongshi ZHANG. Effect of head acupuncture on neurological function and HIF-1α and VEGFR2 expressions in brain tissue in rats with focal cerebral ischemia and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2023, 49(6): 1431-1436.
[15]	Canfei XU,Yan HUANG,Kaizhi ZHANG. Acute ischemic stroke patients with onset time within 4.5 h identified by machine learning combined with magnetic resonance diffusion weighted imaging [J]. Journal of Jilin University(Medicine Edition), 2023, 49(6): 1635-1641.