Carr John Alfred, Haithcock Benjamin E, Paone Gaetano, Bernabei Alvise F, Silverman Norman A
Department of Cardiothoracic Surgery, Henry Ford Health Sciences Center, Detroit, Michigan, USA.
Ann Thorac Surg. 2002 Nov;74(5):1531-6. doi: 10.1016/s0003-4975(02)03944-9.
The aim of this study was to define the potential for long-term survival with severe left ventricular dysfunction after coronary bypass and to quantify any improvement in overall functional status.
Left ventricular dysfunction was confirmed preoperatively and the long-term survival and functional outcome after bypass was determined by follow-up studies obtained during the span of a decade.
From 1/1990 to 12/1999, 86 patients with severe left ventricular dysfunction (mean ejection fraction, 0.18 +/- 0.03; range, 0.10 to 0.20) underwent coronary artery bypass grafting. There were 10 perioperative deaths (11% mortality). The mean survival was 55 months (standard deviation +/- 34 months; range, 2 to 141 months) with an actual 5-year survival rate of 59% (actuarial 5-year 65%, 10-year 33%). Echocardiography obtained between 1 and 6 months, 6 months and 1 year, 1 and 2 years, 2 and 4 years, 4 and 6 years, and 6 and 11 years showed the ejection fraction improved to 0.29 +/- 0.08 (p < 0.001), 0.31 +/- 0.14 (p < 0.002), 0.35 +/- 0.08 (p < 0.001), 0.27 +/- 0.10 (p = 0.002), 0.36 +/- 0.14 (p = 0.004), and 0.30 +/- 0.11 (p = 0.004), respectively. At 1 to 6 months, 6 months to 1 year, and 1 to 2 years, the diastolic left ventricular dimension was unchanged, but the systolic left ventricular dimension decreased significantly from 5.02 +/- 0.77 cm to 4.26 +/- 0.91 cm (p = 0.046), 3.98 +/- 1.43 cm (p = 0.08), and 4.10 +/- 1.14 cm (p = 0.07). The preoperative New York Heart Association classification for all patients improved from 2.8 +/- 0.8 to 1.6 +/- 0.7 (p < 0.001) after a mean of 53 months (standard deviation +/- 34 months).
Patients with severe left ventricular dysfunction can derive long-term benefit from coronary bypass through improved left ventricular contractility as documented by a significantly decreased systolic left ventricular dimension and increased ejection fraction. Successful bypass is associated with a 59% actual 5-year survival rate and significantly improved New York Heart Association functional class.
本研究的目的是确定冠状动脉搭桥术后严重左心室功能障碍患者的长期生存潜力，并量化整体功能状态的任何改善情况。
术前确认左心室功能障碍，并通过十年期间的随访研究确定搭桥术后的长期生存和功能结果。
从1990年1月至1999年12月，86例严重左心室功能障碍患者（平均射血分数为0.18±0.03；范围为0.10至0.20）接受了冠状动脉搭桥术。围手术期死亡10例（死亡率11%）。平均生存期为55个月（标准差±34个月；范围为2至141个月），实际5年生存率为59%（精算5年生存率为65%，10年生存率为33%）。在术后1至6个月、6个月至1年、1至2年、2至4年、4至6年以及6至11年进行的超声心动图检查显示，射血分数分别提高到0.29±0.08（p<0.001）、0.31±0.14（p<0.002）、0.35±0.08（p<0.001）、0.27±0.10（p=0.002）、0.36±0.14（p=0.004）和0.30±0.11（p=0.004）。在1至6个月、6个月至1年以及1至2年时，左心室舒张期内径未改变，但左心室收缩期内径从5.02±0.77厘米显著减小至4.26±0.91厘米（p=0.046）、3.98±1.43厘米（p=0.08）和4.10±1.14厘米（p=0.07）。所有患者术前纽约心脏协会心功能分级在平均53个月（标准差±34个月）后从2.8±0.8改善至1.6±0.7（p<0.001）。
严重左心室功能障碍患者可通过冠状动脉搭桥术获得长期益处，表现为左心室收缩期内径显著减小和射血分数增加，从而改善左心室收缩功能。成功的搭桥手术与59%的实际5年生存率以及纽约心脏协会心功能分级的显著改善相关。
