背景:我们旨在分析伴随迷宫手术对临床和节律结果的影响,严重三尖瓣反流(TR)和持续性心房颤动(AF)患者三尖瓣修复的超声心动图参数。
方法:将患有严重TR和持续性AF并接受三尖瓣(TV)修复的患者纳入研究。原发性TR和继发性TR均包括在本研究中。根据迷宫程序对研究人群进行分层。主要结局是术后15年的主要不良心血管和脑血管事件(MACCE)。进行倾向评分匹配分析以调整基线差异。
结果:纳入了1994年至2021年因严重TR和持续性AF而接受三尖瓣修复的患者,198例(53.4%)患者同时接受迷宫手术。迷宫组10年窦性心律(SR)恢复率为55%。在匹配的队列中,迷宫组显示心源性死亡的累积发生率较低(4.6%vs.14.4%,P=0.131),心力衰竭再入院(8.1%vs.22.2%,P=0.073),和MACCE(21.1%与42.1%,与非迷宫组相比,15年时P=0.029)。迷宫组5年时左心房(LA)直径显着降低(53.3vs.59.6mm,P<0.001)术后较术前水平,两组LA直径随时间的变化差异有统计学意义(P=0.013)。
结论:重度TR和持续性AF患者在TV修复期间的Maze手术显示出可接受的SR率和较低的MACCE率,同时也促进LA逆向重塑。
BACKGROUND: We aimed to analyze the impact of concomitant Maze procedure on the clinical and rhythm outcomes, and echocardiographic parameters in tricuspid repair for patients with severe tricuspid regurgitation (TR) and persistent atrial fibrillation (AF).
METHODS: Patients who had severe TR and persistent AF and underwent tricuspid valve (TV) repair were included in the study. Both primary TR and secondary TR were included in the current study. The study population was stratified according to Maze procedure. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE) at 15 years post-surgery. Propensity-score matching analyses was performed to adjust baseline differences.
RESULTS: Three hundred seventy-one patients who underwent tricuspid repair for severe TR and persistent AF from 1994 to 2021 were included, and 198 patients (53.4%) underwent concomitant Maze procedure. The maze group showed 10-year sinus rhythm (SR) restoration rate of 55%. In the matched cohort, the maze group showed a lower cumulative incidence of cardiac death (4.6% vs. 14.4%, P = 0.131), readmission for heart failure (8.1% vs. 22.2%, P = 0.073), and MACCE (21.1% vs. 42.1%, P = 0.029) at 15 years compared to the non-maze group. Left atrial (LA) diameter significantly decreased in the maze group at 5 years (53.3 vs. 59.6 mm, P < 0.001) after surgery compared to preoperative level, and there was a significant difference in the change of LA diameter over time between the two groups (P = 0.013).
CONCLUSIONS: The Maze procedure during TV repair in patients with severe TR and persistent AF showed acceptable SR rates and lower MACCE rates compared to those without the procedure, while also promoting LA reverse remodeling.