Maslow Andrew D, Regan Meredith M, Panzica Peter, Heindel Stephanie, Mashikian John, Comunale Mark E
Department of Anesthesiology, Rhode Island Hospital, Brown Medical School, Providence 02903, USA.
Anesth Analg. 2002 Dec;95(6):1507-18, table of contents. doi: 10.1097/00000539-200212000-00009.
Patients with severe left ventricular systolic dysfunction (LVSD) undergoing coronary artery bypass grafting (CABG) have an increased risk for morbidity and mortality. The purpose of this study was to assess the association of pre-CABG right ventricular (RV) function with outcome for patients with severe LVSD. We performed a retrospective evaluation of 41 patients with severe LVSD (left ventricular ejection fraction [LVEF] < or =25%) scheduled for nonemergent CABG. Data were obtained from review of medical records, transesophageal echocardiography tapes, and phone interview. The pre- and post-cardiopulmonary bypass (CPB) LVEF and the RV fractional area of contraction (RVFAC) were calculated by using intraoperative transesophageal echocardiography. Group 1 patients had an RVFAC < or =35% (n = 7), whereas Group 2 patients had RVFAC >35% (n = 34). The durations of mechanical ventilation and of intensive care unit and hospital stays are presented as the median. Pre-CABG LVEF was similar between Groups 1 and 2 (15.8% +/- 3.3% versus 17.8% +/- 3.9%). Compared with Group 2, Group 1 patients required greater duration of mechanical ventilation (12 days versus 1 day; P < 0.01), longer intensive care unit (14 versus 2 days; P < 0.01) and hospital (14 versus 7 days; P = 0.02) stays, had a more frequent incidence and severity of LV diastolic dysfunction, and had a smaller change in LVEF immediately after CPB (4.1% +/- 8.3% versus 12.5% +/- 9.2%; P = 0.03). All Group 1 patients died of cardiac causes within 2 yr of surgery; five died during the same hospital admission. Three Group 2 patients died: one of colon cancer at 18 mo after CABG and two of cardiac causes 24 and 48 mo after surgery. A fourth patient was awaiting cardiac transplantation 4 yr after surgery. The remaining Group 2 patients were New York Heart Association Classification I or II. For patients with severe LVSD undergoing CABG, pre-CPB RV dysfunction was associated with poor outcome. Patients with RVFAC >35% had a relatively uneventful perioperative course and good long-term survival, whereas patients with RVFAC < or =35% had a poor early and late outcome. Assessment of RV function is useful to further assess the risk of CABG.
Right ventricular function before cardiopulmonary bypass is associated with poor outcome after coronary artery surgery in patients with poor left ventricular function.
接受冠状动脉旁路移植术（CABG）的严重左心室收缩功能障碍（LVSD）患者发病和死亡风险增加。本研究旨在评估CABG术前右心室（RV）功能与严重LVSD患者预后的相关性。我们对41例计划进行非急诊CABG的严重LVSD患者（左心室射血分数[LVEF]≤25%）进行了回顾性评估。数据通过查阅病历、经食管超声心动图录像带及电话访谈获得。使用术中经食管超声心动图计算体外循环（CPB）前后的LVEF及RV收缩分数面积（RVFAC）。第1组患者的RVFAC≤35%（n = 7），而第2组患者的RVFAC>35%（n = 34）。机械通气时间、重症监护病房住院时间及住院时间以中位数表示。第1组和第2组术前LVEF相似（15.8%±3.3%对17.8%±3.9%）。与第2组相比，第1组患者需要更长的机械通气时间（12天对1天；P<0.01）、更长的重症监护病房住院时间（14天对2天；P<0.01）及住院时间（14天对7天；P = 0.02），LV舒张功能障碍的发生率和严重程度更高，CPB后即刻LVEF的变化更小（4.1%±8.3%对12.5%±9.2%；P = 0.03）。第1组所有患者均在术后2年内死于心脏原因；5例在同一住院期间死亡。第2组3例患者死亡：1例在CABG术后18个月死于结肠癌，2例在术后24个月和48个月死于心脏原因。第4例患者在术后4年等待心脏移植。第2组其余患者为纽约心脏协会心功能分级I或II级。对于接受CABG的严重LVSD患者，CPB前RV功能障碍与不良预后相关。RVFAC>35%的患者围手术期过程相对平稳且长期生存良好，而RVFAC≤35%的患者早期和晚期预后均较差。评估RV功能有助于进一步评估CABG的风险。
体外循环前右心室功能与左心室功能不良患者冠状动脉手术后的不良预后相关。
