澳大利亚的心房颤动手术:我们做得够不够?

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Heart, Lung and Circulation Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI:10.1016/j.hlc.2024.07.007
Frazer Kirk, Matthew S Yong, Lavinia Tran, Andrew Newcomb, Cheng He, Andrie Stroebel
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引用次数: 0

摘要

目的:本研究旨在探讨澳大利亚和新西兰接受心脏手术的患者心房颤动(AF)的当代负担和治疗趋势。这样就可以将当代做法与胸外科医师协会关于心脏手术患者房颤手术治疗的指南建议进行比较:方法:对澳大利亚和新西兰心脏与胸外科医师学会国家心脏手术数据库进行了为期 10 年的回顾性审查,检查了 2011 年至 2021 年期间的所有成人心脏手术患者。根据是否存在房颤对患者进行分组,并进行简单的描述性统计分析,以评估患者的基线人口统计学特征和病前状况。心房颤动的发生率按手术类型进行分析。然后使用简单的描述性统计对房颤手术治疗的趋势进行了分析,检查了单独的左心房阑尾结扎术、单独的手术消融术以及结扎和消融联合术:在过去 10 年中,澳大利亚和新西兰心脏与胸外科医师协会数据库记录了 140,680 名接受心脏手术的患者。21,077名患者(14%)存在心房颤动(AF)。心房颤动患者的年龄普遍较大(72.25 岁对 66.65 岁;P结论:在澳大利亚接受心脏手术的患者中,合并房颤的比例高于之前的报道(14% 对 5%-11% )。尽管强烈建议对接受心脏手术的患者进行房颤手术治疗,而且也有明确证据表明手术治疗房颤有益,但在这一人群中,单独或同时进行左心房阑尾结扎和手术消融的患者仍严重不足。
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Atrial Fibrillation Surgery in Australia: Are We Doing Enough?

Aim: This study aimed to examine contemporary burden and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand. This allows comparison of contemporary practice with the Society of Thoracic Surgeons guideline recommendations for the surgical treatment of AF in patients undergoing cardiac surgery.

Method: A 10-year retrospective review of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database was performed, examining all adult cardiac surgery patients from 2011 to 2021. Patients were grouped by the presence or absence of AF, and simple descriptive statistical analysis was performed to assess baseline demographics and premorbid condition of the patients. The incidence of AF was analysed by type of surgery. Trends for surgical treatment of AF were then analysed using simple descriptive statistics, examining isolated left atrial appendage ligation, isolated surgical ablation, and combined ligation and ablation.

Results: In the last 10 years, the Australian & New Zealand Society of Cardiac & Thoracic Surgeons database has recorded 140,680 patients who underwent cardiac surgery. Atrial fibrillation (AF) was present in 21,077 patients (14%). Patients with AF were generally older (72.25 vs 66.65 years; p<0.001). Among patients undergoing cardiac surgery, AF was more common in female than in male patients (18% vs 13%, respectively). Patients with AF more often had a higher classification of dyspnoea according to the New York Heart Association and lower ejection fractions compared with their AF-free counterparts. The incidence of AF as a comorbid condition was more frequent in patients undergoing mitral valve surgery or combined coronary artery bypass grafting and valve surgery (aortic, mitral, or both) compared with those undergoing isolated coronary or aortic surgery. Only 11.90% (n=2,509) of patients with AF received a combined ablation and left atrial appendage ligation, and 19.54% (n=693) of those received a Cox-Maze IV ablation.

Conclusions: The burden of concomitant AF in patients undergoing cardiac surgery in Australia is higher than previously reported (14% vs 5%-11%). Despite strong recommendation for the surgical management of AF in patients undergoing cardiac surgery and clear evidence of its benefit, both left atrial appendage ligation and surgical ablation independently or concomitantly remain heavily underutilised in this cohort.

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来源期刊
Heart, Lung and Circulation
Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.50
自引率
3.80%
发文量
912
审稿时长
11.9 weeks
期刊介绍: Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
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