| Background:Heart valve disease is often combined with atrial fibrillation(AF),and valve disease secondary to AF increases the risk of myocardial infarction,heart failure,stroke,dementia,and mortality.Restoration of sinus rhythm in patients with heart valve disease is thought to be beneficial in improving long-term prognosis.Surgical treatment of AF has been shown to be feasible and effective.Surgical ablation(SA)of AF at the same time as valve surgery has been reported to be effective in restoring sinus rhythm without increasing the morbidity and mortality of perioperative complications;however,current studies suggest that AF surgery can lead to adverse events such as bleeding and thrombosis,and that postoperative AF recurrence rates are high;patients undergoing mechanical valve replacement require anticoagulation therapy by warfarin the treatment plan for this kind of patient still needs to be explord.Mitral valve lesions are one of the most common lesions in patients with heart valve disease and are most likely to cause AF.due to long-term anticoagulation with warfarin is required after mitral mechanical valve replacement,it is necessary to perform a clinical observational study of mitral mechanical valve replacement with simultaneous radiofrequency ablation of AF.Objective:The purpose of this study was to investigate the therapeutic effect of radiofrequency ablation of atrial fibrillation at the same time as mitral valve mechanical valve replacement,the cardiac function and the conversion rate of atrial fibrillation in the two groups of patients,and to preliminarily analyze the surgical effect and benefit.Methods:Statistical analysis of patients with valvular heart disease and atrial fibrillation admitted to the Department of Cardiovascular Surgery of the Second Affiliated Hospital of Nanchang University from February 2019 to February 2021.According to whether or not to do ablation,they were divided into mitral valve replacement combined with surgical ablation group(82 cases in the experimental group)and the simple mitral valve replacement group(54 cases in the control group).The cardiac function and the conversion rate of atrial fibrillation were measured in the two groups to evaluate the short-term and medium-term curative effect of the patients.Results:A total of 136 patients were enrolled,including 43 males and 93 females;age(55.28 ± 8.87)years;and no patients died during the perioperative period and follow-up.(1)The duration of extracorporeal circulation(CPB)was significantly longer in the experimental group compared with the control group [(113.62±27.89)min vs.(106.76±39.86)min,P=0.034],and the hospitalization cost was increased [(12.28±1.77)million vs.(11.70 ± 2.44)million,P=0.025];the time of aortic blockade[(80.50±23.08)min vs(76.06±31.33)min,P=0.10],ventilator-assisted ventilation time [(20.67±13.78)h vs(19.57±5.42)h,P=0.167],postoperative ICU stay [(3.52±6.44)days vs(3.52±6.44)days,P= 0.255],postoperative hospital stay [(10.18±8.10)days vs.(11.00±7.51)days,P=0.464] were statistically insignificant.(2)After 6 months of follow-up,the left atrial internal diameter was significantly smaller in the experimental group compared with the control group [(44.35±7.68)vs.(48.23±9.28),P=0.008];the left ventricular end-diastolic diameter [(46.91±5.91)vs.(48.49±6.81),P=0.203] and LVEF [(57.62±10.80)vs.(57.66±(9.46),P=0.901]were not statistically significant.(3)In the experimental group,71 patients recovered from AF at 24 h after surgery,with an AF recovery rate of 87.8%;70 patients recovered from AF at discharge,with an AF recovery rate of 85.3%;67 patients recovered from AF at 1-month follow-up,with an AF recovery rate of 81.7%;66 patients recovered from AF at 3-month follow-up,with an AF recovery rate of 80.5%;and 65 patients recovered from AF at6-month follow-up.At 6-month follow-up,there were 65 patients with AF recovery,and the AF recovery rate was 79.3%.In the control group,there were 11 patients with AF recovery at 24 h after surgery,with an AF recovery rate of 24.4%;13 patients with AF recovery at discharge,with an AF recovery rate of 28.9%;12 patients with AF recovery at 1-month follow-up,with an AF recovery rate of 26.7%;10 patients with AF recovery at 3-month follow-up,with an AF recovery rate of 22.2%;9patients with AF recovery at 6-month follow-up,with an AF recovery rate of 16.7%.The conversion rate was 16.7%.(4)Comparison of AF recovery rate between experimental group and control group: after 6 months postoperatively,65 patients(79.2%)in the experimental group and 9 patients(16.7%)in the control group had AF recovery;the AF recovery rate of patients in the experimental group was higher than that in the control group after surgery and at the end of follow-up,and the difference was statistically significant(P<0.001).(5)One case of pulmonary complications and one case of acute renal failure occurred in the experimental group after surgery.One case of permanent pacemaker implantation,one case of stroke,and one case of gastrointestinal bleeding occurred in the control group after surgery;there was no death in both groups.Compared with the control group,the probability of postoperative complications in the experimental group was low(2.43% vs.5.54%,P > 0.05),and radiofrequency ablation of atrial fibrillation performed at the same time may not increase the incidence of postoperative stroke and complications in patients.Conclusion:Atrial fibrillation surgical abltion with mitral mechanical valve replacement in mitral valve disease combine AF effective,and patients may benefit from a significantly lower incidence of atrial fibrillation at 6 months postoperatively than with mitral valve replacement alone. |
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