Suma H, Isomura T, Horii T, Hisatomi K
Department of Cardiovascular Surgery, Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan.
Eur J Cardiothorac Surg. 2001 Aug;20(2):319-23. doi: 10.1016/s1010-7940(01)00780-1.
In order to treat ischemic cardiomyopathy, which is defined as non-aneurysmal diffuse akinetic left ventricle with chronic heart failure following myocardial infarction, the mid-term effect of the endoventricular circular patch plasty (EVCPP) was studied.
EVCPP has been performed on 54 patients (46 men and eight women with a mean age of 61 years) during 4 years from March 1997 to December 2000. Thirty-two patients (59%) were NYHA class III and 22 patients (41%) were class IV. Nine patients (17%) had mild angina pectoris before the operation but others had no chest pain. Single, double, triple, and left main disease were noted in six, 13, 32, and three patients, respectively. Mean left ventricular ejection fraction was 23.3 +/- 6.3% (6--30%). Coronary artery bypass grafting was concomitantly undergone by 51 patients (94%) and mitral valve reconstruction was done on 19 patients (35%).
Two patients (3.7%) needed an intra-aortic balloon pump to wean from cardiopulmonary bypass. Seven patients (12.9%) died in the hospital. Among them, two patients (4.4%) out of 45 patients who underwent elective operation died of stroke and heart failure. Five patients (55.5%) out of nine patients who required emergency operation died of heart failure and multiorgan failure. Late death occurred in six patients (11.1%) due to arrhythmia and heart failure in each of three patients. Out of 41 survivors, 38 patients returned to NYHA class I or II and three patients to class III. Out of 50 patients who underwent left ventricular study before and after operation, ejection fraction increased from 22.8 +/- 6.6 to 36.2 +/- 8.0% and mean left ventricular end-diastolic volume and left ventricular end-systolic volume indices reduced from 152.8 +/- 24.6 to 105.0 +/- 36.5 and from 113.6 +/- 45.7 to 66.4 +/- 28.4 ml/m(2), respectively. Mean pulmonary wedge pressure decreased from 19.1 +/- 8.8 to 14.9 +/- 6.8 mmHg. One-, 2-, and 3-year actuarial survival rates were 87.9, 82.7 and 77.2%, respectively.
Left ventriculoplasty using EVCPP is effective to exclude the akinetic LV segment, and left ventricular function and clinical status improve in patients with ischemic cardiomyopathy.
为治疗缺血性心肌病，其定义为心肌梗死后出现慢性心力衰竭的非室壁瘤性弥漫性运动减弱左心室，研究了心室内环形补片成形术（EVCPP）的中期效果。
1997年3月至2000年12月的4年间，对54例患者（46例男性和8例女性，平均年龄61岁）实施了EVCPP。32例患者（59%）为纽约心脏协会（NYHA）心功能Ⅲ级，22例患者（41%）为Ⅳ级。9例患者（17%）术前有轻度心绞痛，其他患者无胸痛。分别有6例、13例、32例和3例患者存在单支、双支、三支和左主干病变。平均左心室射血分数为23.3±6.3%（6%-30%）。51例患者（94%）同时接受了冠状动脉旁路移植术，19例患者（35%）进行了二尖瓣重建。
2例患者（3.7%）需要主动脉内球囊反搏以脱离体外循环。7例患者（12.9%）在医院死亡。其中，45例接受择期手术的患者中有2例（4.4%）死于中风和心力衰竭。9例需要急诊手术的患者中有5例（55.5%）死于心力衰竭和多器官功能衰竭。后期有6例患者（11.1%）死亡，3例死于心律失常，3例死于心力衰竭。41例幸存者中，38例患者的心功能恢复到NYHAⅠ级或Ⅱ级，3例为Ⅲ级。在50例术前和术后进行左心室研究的患者中，射血分数从22.8±6.6%增加到36.2±8.0%，平均左心室舒张末期容积和左心室收缩末期容积指数分别从152.8±24.6降至105.0±36.5，以及从113.6±45.7降至66.4±28.4ml/m²。平均肺楔压从19.1±8.8降至14.9±6.8mmHg。1年、2年和3年的实际生存率分别为87.9%、82.7%和77.2%。
使用EVCPP进行左心室成形术可有效排除运动减弱的左心室节段，缺血性心肌病患者的左心室功能和临床状况得到改善。
