Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Song ,  WANG Jixiang

Department of Cardiothoracic Surgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, P.R.China;

Corresponding?author：

WANG Jixiang, Email: wjx391@sohu.com

Keywords：

Totally thoracoscopic surgery; median sternotomy; mitral valve replacement; atrial fibrillation; radiofrequency ablation; treatment

DOI：

10.7507/1007-4848.201911050

Video：

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Objective To investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.Methods The clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared.Results All operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up.Conclusion Radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.

Citation： WU Song, WANG Jixiang. Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 874-879. doi: 10.7507/1007-4848.201911050 Copy

1.	劉浩, 周婷. 心房顫動的病理生理和危害. 臨床內科雜志, 2013, 30(1): 5-7.
2.	Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
3.	孟旭. 房顫的外科消融治療進展. 醫學與哲學, 2016, 37(24): 10-12.
4.	Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
5.	Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med, 1923, 16(Electro Ther Sect): 45-62.
6.	Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
7.	Lan H, Cheng YG, Jia BC, et al. Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases. Zhonghua Wai Ke Za Zhi, 2016, 54(8): 609-612.
8.	Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
9.	柳德斌, 王煒, 王瑋璠, 等. 全胸腔鏡下二尖瓣置換/成形 127 例療效分析. 中國循環雜志, 2017, 32(z1): 132-133.
10.	Firmansyah DK, Soesanto AM, Hanafy DA, et al. Cox maze Ⅳversus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
11.	吳松, 王繼相. 心房顫動的外科治療研究進展. 中國心血管病研究, 2018, 16(10): 892-894.
12.	Vannucchi V, Moroni F, Grifoni E, et al. Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke. J Thromb Thrombolysis, 2020, 49(1): 86-93.
13.	Rose DZ, Meriwether JN, Fradley MG, et al. Protocol for AREST: Apixaban for early prevention of recurrent embolic stroke and hemorrhagic transformation-a randomized controlled trial of early anticoagulation after acute ischemic stroke in atrial fibrillation. Front Neurol, 2019, 10: 975.
14.	Jewett GA, Lindsay MP, Goia C, et al. National trends in hospital admission, case fatality, and sex differences in atrial fibrillation-related strokes. Int J Stroke, 2019. [Epub ahead of print].
15.	郭秋哲, 郭應強. 心房顫動外科治療的歷史與現狀. 心血管病學進展, 2013, 34(3): 356-359.
16.	Cox JL. Surgical management of cardiac arrhythmias. Cardiovasc Clin, 1987, 17(3): 381-413.
17.	Zhang Y, Zhu L. Surgical ablation of atrial fibrillation. Int J Cardiol Heart Vessel, 2014, 4: 7-11.
18.	Lapenna E, De Bonis M, Giambuzzi I, et al. Long-term outcomes of stand-alone mazeⅣfor persistent or long-standing persistent atrial fibrillation. Ann Thorac Surg, 2020, 109(1): 124-131.
19.	Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-mazeⅣprocedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
20.	譚程, 孫小康, 黃磊. 二尖瓣機械瓣膜置換同期行雙極射頻消融術治療心房顫動的早期療效. 四川醫學, 2016, 37(7): 788-790.
21.	Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
22.	陳波. 微創全胸腔鏡與傳統正中開胸二尖瓣置換手術的傾向性評分匹配研究. 汕頭大學, 2017.
23.	萬麗麗. 全胸腔鏡下二尖瓣置換手術的安全性研究. 中華實驗外科雜志, 2019, 36(8): 1479-1481.
24.	Fan H, Xi Ming Q, Wei Min Z, et al. Comparison of totally thoracoscopic and traditional sternotomy approaches for mitral valve replacement. Heart Surg Forum, 2019, 22(4): E310-E314.
25.	Zhao G, Gao J, Liu Y, et al. Two-incision totally thoracoscopic approach for mitral valve replacement. Int Heart J, 2017, 58(6): 894-899.
26.	Ha?ssaguerre M, Ja?s P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339(10): 659-666.
27.	葉紅雨, 黃偉釗, 吳穎猛, 等. 術中單極和雙極射頻消融治療心房纖顫的療效與安全性比較. 實用醫學雜志, 2013, 29(1): 75-77.
28.	陳磊, 沈振亞, 余云生, 等. 房顫患者射頻消融術治療療效分析. 浙江臨床醫學, 2016, 18(11): 2001-2003.
29.	陳哲. 瓣膜手術中行雙極射頻消融術與單極射頻消融術治療房顫的比較. 浙江大學, 2013.
30.	劉澗, 孫玉喜, 黎輝. 心房顫動射頻消融術后復發的相關因素研究. 國際心血管病雜志, 2017, 44(6): 341-343.
31.	顧聞達, 郭惠明, 盧聰, 等. 心臟手術同期射頻消融治療房顫的中長期療效分析. 中華胸心血管外科雜志, 2016, 32(3): 147-150.
32.	王曉雅, 徐燕爽, 葉卉. 持續性房顫患者射頻消融術中體表心電圖 V1 導聯 f 波振幅與術后復發的關系. 山東醫藥, 2016, 56(10): 60-61.
33.	歐石, 戴明, 陳中堅, 等. 單雙極射頻消融術治療心房顫動的療效及安全性比較. 中國實用醫刊, 2015, 42(2): 98-99.

1. 劉浩, 周婷. 心房顫動的病理生理和危害. 臨床內科雜志, 2013, 30(1): 5-7.
2. Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
3. 孟旭. 房顫的外科消融治療進展. 醫學與哲學, 2016, 37(24): 10-12.
4. Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
5. Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med, 1923, 16(Electro Ther Sect): 45-62.
6. Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
7. Lan H, Cheng YG, Jia BC, et al. Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases. Zhonghua Wai Ke Za Zhi, 2016, 54(8): 609-612.
8. Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
9. 柳德斌, 王煒, 王瑋璠, 等. 全胸腔鏡下二尖瓣置換/成形 127 例療效分析. 中國循環雜志, 2017, 32(z1): 132-133.
10. Firmansyah DK, Soesanto AM, Hanafy DA, et al. Cox maze Ⅳversus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
11. 吳松, 王繼相. 心房顫動的外科治療研究進展. 中國心血管病研究, 2018, 16(10): 892-894.
12. Vannucchi V, Moroni F, Grifoni E, et al. Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke. J Thromb Thrombolysis, 2020, 49(1): 86-93.
13. Rose DZ, Meriwether JN, Fradley MG, et al. Protocol for AREST: Apixaban for early prevention of recurrent embolic stroke and hemorrhagic transformation-a randomized controlled trial of early anticoagulation after acute ischemic stroke in atrial fibrillation. Front Neurol, 2019, 10: 975.
14. Jewett GA, Lindsay MP, Goia C, et al. National trends in hospital admission, case fatality, and sex differences in atrial fibrillation-related strokes. Int J Stroke, 2019. [Epub ahead of print].
15. 郭秋哲, 郭應強. 心房顫動外科治療的歷史與現狀. 心血管病學進展, 2013, 34(3): 356-359.
16. Cox JL. Surgical management of cardiac arrhythmias. Cardiovasc Clin, 1987, 17(3): 381-413.
17. Zhang Y, Zhu L. Surgical ablation of atrial fibrillation. Int J Cardiol Heart Vessel, 2014, 4: 7-11.
18. Lapenna E, De Bonis M, Giambuzzi I, et al. Long-term outcomes of stand-alone mazeⅣfor persistent or long-standing persistent atrial fibrillation. Ann Thorac Surg, 2020, 109(1): 124-131.
19. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-mazeⅣprocedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
20. 譚程, 孫小康, 黃磊. 二尖瓣機械瓣膜置換同期行雙極射頻消融術治療心房顫動的早期療效. 四川醫學, 2016, 37(7): 788-790.
21. Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
22. 陳波. 微創全胸腔鏡與傳統正中開胸二尖瓣置換手術的傾向性評分匹配研究. 汕頭大學, 2017.
23. 萬麗麗. 全胸腔鏡下二尖瓣置換手術的安全性研究. 中華實驗外科雜志, 2019, 36(8): 1479-1481.
24. Fan H, Xi Ming Q, Wei Min Z, et al. Comparison of totally thoracoscopic and traditional sternotomy approaches for mitral valve replacement. Heart Surg Forum, 2019, 22(4): E310-E314.
25. Zhao G, Gao J, Liu Y, et al. Two-incision totally thoracoscopic approach for mitral valve replacement. Int Heart J, 2017, 58(6): 894-899.
26. Ha?ssaguerre M, Ja?s P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339(10): 659-666.
27. 葉紅雨, 黃偉釗, 吳穎猛, 等. 術中單極和雙極射頻消融治療心房纖顫的療效與安全性比較. 實用醫學雜志, 2013, 29(1): 75-77.
28. 陳磊, 沈振亞, 余云生, 等. 房顫患者射頻消融術治療療效分析. 浙江臨床醫學, 2016, 18(11): 2001-2003.
29. 陳哲. 瓣膜手術中行雙極射頻消融術與單極射頻消融術治療房顫的比較. 浙江大學, 2013.
30. 劉澗, 孫玉喜, 黎輝. 心房顫動射頻消融術后復發的相關因素研究. 國際心血管病雜志, 2017, 44(6): 341-343.
31. 顧聞達, 郭惠明, 盧聰, 等. 心臟手術同期射頻消融治療房顫的中長期療效分析. 中華胸心血管外科雜志, 2016, 32(3): 147-150.
32. 王曉雅, 徐燕爽, 葉卉. 持續性房顫患者射頻消融術中體表心電圖 V1 導聯 f 波振幅與術后復發的關系. 山東醫藥, 2016, 56(10): 60-61.
33. 歐石, 戴明, 陳中堅, 等. 單雙極射頻消融術治療心房顫動的療效及安全性比較. 中國實用醫刊, 2015, 42(2): 98-99.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery

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