Blanche C, Khan S S, Matloff J M, Chaux A, DeRobertis M A, Czer L S, Kass R M, Tsai T P
Department of Thoracic and Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048.
J Thorac Cardiovasc Surg. 1992 Oct;104(4):961-5.
A 10-year experience with early operation for postinfarction ventricular septal defect is reviewed. Twenty-two patients underwent surgical repair; operative mortality was 36% (< 30 days). The actuarial survival was 64% at 1 month, 59% at 1 year, and 47% at 5 years. Risk factors predictive of operative mortality were diabetes (p = 0.001), elevated preoperative right atrial pressure (p = 0.02), the absence of a preoperative intraaortic balloon pump (p = 0.006), and a short time interval between infarct and operation (p = 0.018). Long-term survival was adversely related to diabetes (p = 0.030), elevated preoperative right atrial pressure (p = 0.005), and, surprisingly, survival was better in patients with a greater extent of coronary artery disease (p = 0.023). There were 14 operative survivors (64%) and 11 long-term survivors (3 months to 10 years, mean 6.0 +/- 3.5 years). Six of eleven survivors were in functional New York Heart Association class I, one was in class II, and four were in class III.
回顾了10年对心肌梗死后室间隔缺损进行早期手术的经验。22例患者接受了手术修复；手术死亡率为36%（<30天）。1个月时的精算生存率为64%，1年时为59%，5年时为47%。预测手术死亡率的危险因素包括糖尿病（p = 0.001）、术前右心房压力升高（p = 0.02）、术前未使用主动脉内球囊反搏（p = 0.006）以及梗死与手术之间的时间间隔短（p = 0.018）。长期生存与糖尿病（p = 0.030）、术前右心房压力升高（p = 0.005）呈负相关，令人惊讶的是，冠状动脉疾病程度较重的患者生存率更高（p = 0.023）。有14例手术幸存者（64%）和11例长期幸存者（3个月至10年，平均6.0±3.5年）。11名幸存者中有6名纽约心脏协会心功能分级为I级，1名是II级，4名是III级。
