The page contains the following sections:
When is surgical repair of a heart rhythm disturbance advisable?
How is repair of a heart rhythm disturbance accomplished?
What are the risks and benefits of such surgery?
What is involved in a typical recovery?
When is surgical repair of a heart rhythm disturbance advisable?
心房纤颤 (often referred to as AFib or AF) is the most common kind of arrhythmia, or disturbance of the heart's rhythm. Arrhythmias are caused by a malfunction of your heart's 电气系统; in the case of AFib, your heart beats with an irregular rhythm. 因此，可能没有足够的富氧血液来满足你身体的需要. 这最终会导致 胸部疼痛, 心脏衰竭 或者形成可能导致中风的血凝块(大约15%的中风发生在房颤患者身上).
如果你被诊断患有心房纤颤, 你的外科医生会评估你的具体情况，并帮助你权衡心脏手术的风险与继续用药物治疗的风险, other nonsurgical treatments or implantation of a pacemaker. 通常，如果你的症状不严重，可以通过改变生活方式和/或药物治疗来控制. 通常, AFib的矫正通常与其他心脏手术同时进行, the repair of a defective aortic or mitral valve. 偶尔, 然而, 心房颤动引起的丧失行为能力的症状，心脏手术来解决心律失常是作为一个独立的程序.
Should you and your surgeon decide the time is right for surgery, 请记住，我们的心脏外科医生在所有经过验证的心房颤动矫正方案方面都有相当的专业知识.
How is repair of a heart rhythm disturbance accomplished?
There are several ways to restore your heart to a normal rhythm. Your surgeon will consider various factors—such as your age, 你的整体健康状况, 以及你的心房纤颤是慢性的还是偶发性的——来决定哪种选择最有效:
- 心脏消融术 包括使用高频无线电波或极冷来破坏心脏电系统的受损部分. The technique that uses radio waves is known as radiofrequency ablation, and the technique that uses cold is known as cryoablation. ("Ablation" comes from Latin words meaning "take away from" or "remove," while "cryo" comes from a Greek word meaning "frost.")
- 迷宫程序 它包括在你的心房表面做一个微小的伤口，也就是所谓的损伤，就像一个小迷宫, hence the procedure's name; the lesions disrupt the uncoordinated electrical signals that cause AFib.
- 一种改进的迷宫程序被称为Cox-Maze IV程序，包括使用多种技术的组合. 一些病变是使用传统的迷宫过程产生的，其他病变是使用射频波或低温能量(冷)产生的。. This allows the procedure to be completed much more efficiently.
All of these procedures can be performed via open-heart surgery, minimally invasive surgery or endovascular surgery. When they're done at the same time as another procedure, 这是通常的情况, 手术的要求通常决定了哪种手术入路是最合适的:
- 开胸手术 纠正心律失常需要在胸骨中间做一个8到10英寸的切口, 或胸骨, then dividing the sternum to allow access to the heart. 在某些情况下，可能采用侵入性较小的选择，包括稍小的胸骨切口. Then the chosen procedure is performed through the incision.
It will be necessary to stop your heart from beating during the procedure, so the operation can be performed on a motionless and bloodless field; while your heart is stopped, 一种被称为心肺旁路机的设备将接管你的心脏功能并维持血液循环. 偶尔, during complex operations also involving the aorta, you may be put into a state known as hypothermic circulatory arrest; this involves lowering your body temperature to significantly slow your body's cellular activity, permitting your blood flow to be temporarily stopped. (The term "hypothermic" comes from Greek words meaning "low heat," while "circulatory arrest" means your circulation is arrested, 或停止.)在其他情况下, a technique known as axillary cannulation (or the insertion of a drainage tube, 被称为套管, 在你腋窝的动脉里, or axilla) can allow aortic replacement to be performed without hypothermic circulatory arrest; this advance may reduce the incidence of postoperative strokes and neurological deficits.
- 微创手术 包括在你的胸部侧面做一个或两个较小的切口(通常是2到4英寸), 在你的肋骨之间. Then the procedure is performed by inserting a tiny camera and long, thin surgical instruments through your tissues to your heart. 微创手术 also requires the use of a heart-lung bypass machine. In addition, it may require a period of hypothermic circulatory arrest. In circumstances when it is appropriate, this approach avoids the need to split the sternum and open the entire chest, 因此，复苏可能会更快.
- 血管内手术, another type of minimally invasive surgery, involves making a couple of tiny incisions (often just 1 to 2 inches) in blood vessels in your groin; inserting long, thin tubes known as a catheters through the vessels to your heart; and then using X-ray guidance and long, thin instruments threaded through the catheters to perform the procedure. (The term "endovascular" comes from Greek and Latin words meaning "within a vessel.") There is also a specific form of endovascular surgery called transcatheter aortic valve replacement (TAVR).
In circumstances when it is appropriate, endovascular surgery can sometimes be done with the patient under local rather than general anesthesia; in addition, 它通常不需要低温循环停搏或使用心肺旁路机. 在相对罕见的情况下，心脏节律手术是单独进行的, it can often be done as an endovascular procedure. Since this approach avoids the need to open the chest at all, it usually results in much faster healing.
What are the risks and benefits of such surgery?
重要的是要记住，每一个医疗选择都涉及风险和收益之间的权衡——无论是接受手术, 服药, or even just carefully monitor a condition (an option known as "watchful waiting").
就AFib而言, 决定心脏手术是否可取，需要权衡任何心脏手术的风险，以及继续使用药物和其他非手术治疗来控制心律失常(以及任何相关的瓣膜问题)的风险.
The risks involved in surgery are typically quite low. 由于AFib的手术通常与另一种外科手术同时进行, 总的风险通常与正在执行的任何其他程序相同. 换句话说, 进行心脏消融或迷宫手术通常不会导致任何额外的风险.
如果对节律障碍的纠正是成功的——50%到70%的患者都是如此——那么益处是相当可观的. 通常, 患者可以停止服用血液稀释药物(通常指的是香豆素的品牌名称), 他们的症状减轻了, and the progressive damage to their heart is dramatically slowed or halted.
What is involved in a typical recovery?
A typical open-heart procedure takes from 4 to 6 hours, in some cases up to 8 hours; patients are then maintained under general anesthesia for an additional 4 to 6 hours. If their heart is performing well and there is no excess bleeding, they can emerge from anesthesia and have their breathing tube removed. Most patients stay in the ICU until midday of the day after their procedure; if they continue to do well, 然后可以移除胸腔中的引流管，当天晚些时候可以将他们转移到普通的医院病床上.
The typical hospital stay ranges from 4 to 7 days. 在这一点上, the vast majority of patients are able to go home, with support from the visiting nurse service, 虽然大约15%到30%的人可能需要在康复机构花一些时间进行更广泛的康复. 出院后, 建议患者在三周内不要开车，在六周内不要举起超过5磅的东西. Beyond that point, they can resume whatever activities they wish to.
病人 tend to be surprised at how easy it is to control their pain. By the second day after their operation, most patients are comfortable without intravenous pain medication, 只服用口服止痛药, and the overwhelming majority are discharged home on just Tylenol or Motrin.
In cases when minimally invasive surgery is appropriate, the recovery period may be shorter (much shorter in the case of endovascular surgery).
审查页面:2018年6月26日
Page reviewed by: Jock McCullough, MD