Athanasuleas C L, Stanley A W, Buckberg G D, Dor V, Di Donato M, Siler W
Department of Cardiac Surgery, Norwood Clinic and Kemp-Carraway Heart Institute, Birmingham, AL 35234, USA.
Semin Thorac Cardiovasc Surg. 2001 Oct;13(4):448-58. doi: 10.1053/stcs.2001.30372.
Anterior infarction changes ventricular shape and volume. Akinesia is most commonly observed after early reperfusion. Dyskinesia develops in the absence of reperfusion. Both produce heart failure by dysfunction of the remote muscle. Traditional surgery deals with dyskinesia. This study evaluates surgical anterior ventricular endocardial restoration (SAVER), an operation that excludes the apical and septal scar in both akinesia and dyskinesia. A new international group of cardiologists and surgeons from 13 centers, the RESTORE Group) investigated SAVER in ischemic cardiomyopathy following anterior infarction. From January 1998 to July 2000, 662 patients underwent surgery. Early and 3-year outcomes were investigated. Concomitant procedures included coronary artery bypass grafting (CABG) in 92%, mitral repair in 22%, and mitral replacement in 3%. Hospital mortality was 7.7%. Mortality among 606 patients with SAVER and CABG alone was 4.9%. It was 8.1% among 147 patients who underwent concomitant mitral valve repair. Few patients required IABPs (8.4%), LVADs (0.4%), or ECMO (0.6%). Postoperatively, ejection fraction increased from 29.7% +/- 11.3% to 40.0% +/- 12.3% and left ventricular end systolic volume decreased from 96 +/- 63 to 62 +/- 39 mL/m(2) (P <. 05). At 3 years, the survival rate was 89.4% +/- 1.3%. Survival was lower among those with preoperative volume >80 mL/m(2) compared with volume < or = 80 mL/m(2) (83.5% +/- 3.3% v 94.5% +/- 2.0%). Freedom from readmission to hospital for heart failure was at 88.7% at 3 years and was not related to preoperative volume. SAVER is a safe and effective procedure for treating the remodeled dilated anterior ventricle following anterior myocardial infarction.
前壁梗死会改变心室形状和容积。运动不能最常见于早期再灌注后。运动障碍在未进行再灌注时出现。两者均通过远隔心肌功能障碍导致心力衰竭。传统手术用于治疗运动障碍。本研究评估了外科前心室心内膜修复术（SAVER），这是一种在运动不能和运动障碍时均排除心尖和室间隔瘢痕的手术。一个由来自13个中心的心脏病专家和外科医生组成的新国际团队（RESTORE组）对前壁梗死后缺血性心肌病中的SAVER进行了研究。1998年1月至2000年7月，662例患者接受了手术。对早期和3年的结果进行了研究。同期手术包括92%的冠状动脉旁路移植术（CABG）、22%的二尖瓣修复术和3%的二尖瓣置换术。医院死亡率为7.7%。仅接受SAVER和CABG的606例患者的死亡率为4.9%。在147例接受同期二尖瓣修复术的患者中为8.1%。很少有患者需要主动脉内球囊反搏（IABP）（8.4%）、左心室辅助装置（LVAD）（0.4%）或体外膜肺氧合（ECMO）（0.6%）。术后，射血分数从29.7%±11.3%增加到40.0%±12.3%，左心室收缩末期容积从96±63降至62±39 mL/m²（P<.05）。3年时，生存率为89.4%±1.3%。术前容积>80 mL/m²的患者生存率低于容积≤80 mL/m²的患者（83.5%±3.3%对94.5%±2.0%）。3年时因心力衰竭再次入院的自由度为88.7%，且与术前容积无关。SAVER是治疗前壁心肌梗死后重塑扩张的前心室的一种安全有效的手术。
