心房功能性二尖瓣反流伴行迷宫手术和二尖瓣修复后植入起搏器
Pacemaker implantation after concomitant maze procedure and mitral valve repair in atrial functional mitral regurgitation.
摘要(中文译文)
心房功能性二尖瓣反流（AFMR）由心房颤动（AF）所致的心房扩大和二尖瓣环扩张引起。尽管已有关于AFMR患者二尖瓣手术结局的报道，但AFMR患者同期行Maze手术的结局仍知之甚少。本研究旨在评估AFMR患者同期行二尖瓣成形术和Maze手术的临床结局和心律结局。我们回顾性分析了2010年8月至2025年6月期间接受二尖瓣成形术（修复）同期行Maze手术的122例患者。队列分为AFMR组（n=50）和非AFMR组（n=72）。采用以死亡为竞争风险的Fine-Gray亚分布风险模型分析永久起搏器（PPM）植入的累积发生率。采用连续时间多状态马尔可夫模型评估术后心律动态变化。AFMR组PPM植入的总体累积发生率显著高于非AFMR组（P<0.001）。虽然早期（≤30天）PPM植入率无差异（P=0.53），但AFMR组晚期（>30天）PPM植入风险更高（P<0.001）。多变量分析确定AFMR为晚期PPM植入的独立危险因素[亚分布风险比（sHR）14.963，P=0.02]。此外，与非AFMR组相比，AFMR组术后交界性心律的发生率更高。与非AFMR组相比，AFMR与Maze手术后总体生存率和主要不良心血管事件发生率无统计学显著差异。然而，AFMR与Maze手术后向交界性心律转变的风险较高相关，而后者与PPM植入率增加相关。值得注意的是，起搏器植入风险主要为晚发，这可能归因于窦房结功能的进行性衰退。因此，有必要进行密切的长期心律监测和随访。
Abstract
Atrial functional mitral regurgitation (AFMR) is caused by atrial enlargement and mitral annular dilation due to atrial fibrillation (AF). Although the outcomes of mitral valve surgery in AFMR have been reported, concomitant Maze procedure outcomes in AFMR remain poorly understood. This study aimed to evaluate the clinical and rhythm outcomes of concomitant mitral valve plasty and the Maze procedure in patients with AFMR. We retrospectively analyzed 122 patients who underwent the mitral valve plasty (repair) concomitant with Maze procedure between August 2010 and June 2025. The cohort was divided into an AFMR group (n=50) and a non-AFMR group (n=72). The cumulative incidence of permanent pacemaker (PPM) implantation was analyzed using the Fine-Gray subdistribution hazard model with death as a competing risk. Postoperative rhythm dynamics were evaluated using a continuous-time multi-state Markov model. The overall cumulative incidence of PPM implantation was significantly higher in the AFMR group than in the non-AFMR group (P<0.001). While early (≤30 days) PPM implantation rates did not differ (P=0.53), the AFMR group showed a higher risk of late (>30 days) PPM implantation (P<0.001). Multivariable analysis identified AFMR as an independent risk factor of late PPM implantation [subdistribution hazard ratios (sHR) 14.963, P=0.02]. Furthermore, the AFMR group demonstrated a higher rate of postoperative junctional rhythm compared to the non-AFMR group. AFMR was not associated with a statistically significant difference in overall survival and the incidence of major adverse cardiovascular events following the Maze procedure compared to the non-AFMR group. However, AFMR was associated with a higher risk of transition to junctional rhythm following the Maze procedure, which was associated with an increased rate of PPM implantation. Notably, the risk of pacemaker implantation was predominantly late-onset, which may be due to a progressive decline in sinus node function. Therefore, close long-term rhythm monitoring and follow-up are warranted.
如何引用
AMA
Jung Uk Woo, Sungsil Yoon, Woo Sung Jang, Yun Seok Kim, YoHan Bae, Hee Jeong Lee, et al. Pacemaker implantation after concomitant maze procedure and mitral valve repair in atrial functional mitral regurgitation.. Journal of thoracic disease. 2026; doi:10.21037/jtd-2025-1-2790.
APA
Jung Uk Woo, Sungsil Yoon, Woo Sung Jang, Yun Seok Kim, YoHan Bae, Hee Jeong Lee, et al (2026). Pacemaker implantation after concomitant maze procedure and mitral valve repair in atrial functional mitral regurgitation.. Journal of thoracic disease. https://doi.org/10.21037/jtd-2025-1-2790
GB/T 7714
Jung Uk Woo, Sungsil Yoon, Woo Sung Jang, Yun Seok Kim, YoHan Bae, Hee Jeong Lee, et al. Pacemaker implantation after concomitant maze procedure and mitral valve repair in atrial functional mitral regurgitation.[J]. Journal of thoracic disease, 2026 doi:10.21037/jtd-2025-1-2790.
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