OJAI, California (EGMN) – The presence of atrial fibrillation tends to decrease survival time following valve surgery, and some studies have shown that medical treatment of AF does not improve survival.

But a new retrospective analysis by Dr. Richard Lee of Northwestern University, Evanston, Illinois, suggests that when AF is treated with the maze procedure during valve repair, patients survive just as long as do those without AF.

“We think the effect, if reproducible, may be due to the higher rate of sinus restoration from the surgical treatment as opposed to medical treatment,” Dr. Lee said at the annual meeting of the Western Thoracic Surgical Association. “Concomitant AF treatment should be strongly considered in all patients with a history of AF undergoing cardiac surgery.”

The study involved 3,337 patients who underwent valve surgery at a single institution between April 2004 and April 2009. Of those, 17% had the maze procedure for AF at the same time as their valve repair.

Dr. Lee followed the patients for up to 6 years using the U.S. Social Security death index and registry. As expected, initial Kaplan-Meier analysis confirmed that survival after valve repair was shorter for patients with AF than for those without it.

Patients with AF on average were significantly older, more likely to be female, and more likely to have heart failure or severe pulmonary hypertension compared with their non–AF counterparts.

Dr. Lee next compared two groups of patients with AF. The group who underwent the maze procedure at the time of valve surgery had significantly longer survival than did those who did not undergo the procedure.

Once again, however, the two groups differed significantly in several demographic characteristics. For example, the AF patients who underwent the maze procedure were significantly more likely to be female, and less likely to have heart failure or diabetes than were those who did not have the procedure. These differences made it difficult to conclude that the maze procedure had led to the longer survival.

To overcome that obstacle, Dr. Lee conducted a propensity matched analysis comparing 378 patients with AF who underwent the maze procedure with 378 patients who did not have AF. There were no significant demographic differences between those two groups. Importantly, there also were no differences in survival time according to Kaplan-Meier analysis. The 5-year survival rate for patients with AF who underwent the maze procedure was 89%, compared with 85% among patients without AF.

There also were no significant differences between groups in a number of other characteristics, including length of hospital stay, 30-day mortality, overall mortality, and cardiac death.

The lack of significant differences between the two groups persisted when Dr. Lee looked at subgroups of patients who had mitral valve repair, aortic valve repair, or coronary artery bypass grafting in addition to valve repair.

Dr. Lee acknowledged several limitations of the study. It involved a relatively small sample at a single institution, and selection bias might have eliminated the highest-risk AF patients. In addition, he was unable to compare successful AF treatment with unsuccessful treatment.

Nevertheless, Dr. Lee strongly suggests surgical repair of AF, especially since it adds just 10-20 minutes to valve repair surgery.

Dr. Lee disclosed that he has served as a consultant to, and has received research funding from, Medtronic.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

加利福尼亚州奥哈伊(EGMN)——患者存在房颤往往会缩短其瓣膜手术后的生存时间，且某些研究已表明对房颤进行药物治疗并没有改善患者生存。

 

但由伊利诺斯州埃文斯顿西北大学的Richard Lee博士进行的一项新的回顾性分析表明，在瓣膜修补术过程中行迷宫手术治疗房颤时，患者的生存时间与无房颤者等长。

 

Lee博士在西部胸外科医师协会年会上说：“我认为这种作用(若为可再现性)可能归因于手术治疗引起的转复为窦性心律的发生率高于药物治疗”。“对于所有行心脏手术、有房颤病史的患者均强烈推荐行同步房颤手术治疗。”

 

该研究包括3,337例在2004年4月~2009年4月期间在单个医疗机构行瓣膜手术的患者，其中17%在行瓣膜修补术过程中行迷宫手术治疗房颤。

 

Lee博士利用美国社会保障死亡指数和登记处对患者随访达6年。正如所料，初始的Kaplan-Meier分析证实在瓣膜修补术过程中未行房颤治疗者术后生存时间较短。

 

总体而言，与相匹配的无房颤患者相比，房颤患者年龄明显偏大，以女性居多，且更可能发生心力衰竭或重度肺动脉高血压。

 

Lee博士接下来对两组房颤患者进行比较。在进行瓣膜手术时行迷宫手术治疗组生存时间相对于未行迷宫手术者显著延长。

 

然而，两组之间又在多个人口学特征方面有显著差异。例如，行迷宫手术的房颤患者中女性往往显著偏多，发生心力衰竭或糖尿病的几率小于未行此手术者。这些差异的存在，使人很难断言生存时间较长归因于迷宫手术。

 

为克服此障碍，Lee博士进行了倾向性匹配分析：对378例行迷宫手术的房颤患者与378例无房颤的患者进行比较。这两组患者无显著的人口学差异。重要的是，据Kaplan-Meier分析，两组患者的生存时间亦无显著差异。行迷宫手术的房颤患者5年生存率为89%，而无房颤患者为85%。

 

其他许多特征均无明显的组间差异，其中包括住院时间、30天死亡率、总死亡率以及心源性死亡。

 

Lee博士对行二尖瓣修补术、主动脉瓣修补术或瓣膜修补术辅以冠脉搭桥术的亚组患者进行观察时发现，两组之间仍无显著差异。

 

Lee博士坦言本研究存在多个局限性，其中包括单个医疗机构的样本量相对较小，选择偏倚可能排除了高危房颤患者。另外，他未能对成功的房颤治疗与未成功的房颤治疗进行比较。

 

尽管如此，Lee博士仍强烈推荐进行房颤外科修复手术，该手术仅将瓣膜修补术延长10~20 min。

 

Lee博士披露其本人担任美敦力公司的顾问并收到了该公司的研究基金。

 

爱思唯尔 版权所有