Castiglioni Alessandro, Quarti Andrea, Schreuder Jan, Blasio Andrea, Benussi Stefano, Torracca Lucia, Maisano Francesco, Alfieri Ottavio
Division of Cardiac Surgery, San Raffaele Hospital, Milan, Italy.
Ital Heart J. 2002 Jun;3(6):370-4.
Surgical left ventricular reduction is under investigation as an alternative to, or a bridge for, heart transplantation in patients with a left ventricular aneurysm. In fact, acute myocardial infarction can result in the development of a dyskinetic or akinetic left ventricular aneurysm which may in turn cause congestive heart failure, ventricular arrhythmias, and the formation of mural thrombi. The aim of this study was to evaluate the current operative risk of surgical restoration of the left ventricle and the early and late clinical results.
From January 1997 to December 2001, 94 patients (84 males and 10 females) presenting with a postinfarction aneurysm were submitted to surgical restoration of the left ventricle. All patients presented with symptoms of heart failure and/or angina. The preoperative NYHA functional class was: I in 6 patients, II in 22 patients, and III in 66 patients. No patient was in NYHA class IV at the time of surgery. The preoperative ejection fraction was 30 +/- 7.9%. In 25 patients mural thrombi were identified and surgically removed. In patients with preoperative evidence of ventricular arrhythmias the Harken procedure was performed intraoperatively. The ventricular preoperative and postoperative performances were also studied in 10 patients using P-V loops obtained through a conductance catheter.
The in-hospital mortality was 3.2%. The mean length of hospitalization was 7 +/- 2.9 days. At follow-up (mean 26 +/- 14.8 months) we observed an early improvement in the ejection fraction (30 +/- 7.9 vs 48 +/- 8.0%) and a decrease in the end-diastolic and end-systolic volumes and mean pulmonary pressure (139 +/- 37 vs 84 +/- 17 ml/m2, 105 +/- 39 vs 52 +/- 20 ml/m2, 35 +/- 8.4 vs 23 +/- 4.3 mmHg).
These results suggest that ventricular restoration is indicated in all patients with a postinfarction dyskinetic or akinetic aneurysm. The operation, if performed appropriately, is associated with a low in-hospital mortality and morbidity. A postoperative improvement in the early and long-term cardiac functions was demonstrated. An improvement in symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.
对于患有左心室室壁瘤的患者，正在研究外科左心室重建术，作为心脏移植的替代方法或桥梁。事实上，急性心肌梗死可导致运动障碍或运动不能性左心室室壁瘤的形成，进而可能引起充血性心力衰竭、室性心律失常及壁血栓形成。本研究的目的是评估目前左心室手术修复的手术风险以及早期和晚期临床结果。
1997年1月至2001年12月，94例（84例男性和10例女性）患有心肌梗死后室壁瘤的患者接受了左心室手术修复。所有患者均有心力衰竭和/或心绞痛症状。术前纽约心脏协会（NYHA）心功能分级为：6例为I级，22例为II级，66例为III级。手术时无患者处于NYHA IV级。术前射血分数为30±7.9%。25例患者发现有壁血栓并进行了手术清除。术前有室性心律失常证据的患者术中采用哈肯手术。还使用通过电导导管获得的压力-容积环对10例患者的术前和术后心室功能进行了研究。
住院死亡率为3.2%。平均住院时间为7±2.9天。随访（平均26±14.8个月）时，我们观察到射血分数早期改善（30±7.9%对48±8.0%），舒张末期和收缩末期容积以及平均肺动脉压降低（139±37对84±17ml/m²，105±39对52±20ml/m²，35±8.4对23±4.3mmHg）。
这些结果表明，所有患有心肌梗死后运动障碍或运动不能性室壁瘤的患者均适合进行心室重建术。如果手术操作得当，该手术的住院死亡率和发病率较低。术后早期和长期心脏功能均有改善。症状和生活质量得到改善，这增加了我们对长期生存率提高的期望。
