Tabry I F, Geha A S, Hammond G L, Baue A E
Section of Thoracic and Cardiovascular Surgery, Department of Surgery, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT 06510, USA.
Circulation. 1978 Sep;58(3 Pt 2):I166-70.
We studied 51 patients with coronary artery disease over a 32-month period to determine the effect of coronary revascularization or ventricular resection on ventricular tachyarrhythmias. In these patients, whose major indications for operation were tachyarrhythmias, operative mortality was 18% (9/51). Myocardial infarction could not be documented in 16 patients, including four resuscitated from an arrest; 15 underwent coronary grafting, and one had grafting and mitral valve replacement, with one hospital death. Premature ventricular contractions (PVCs) persist in four of the 15 survivors; all those who had an arrest are free of PVCs. The other 35 patients had documented infarction, associated with an arrest in 19. Grafting only was required in 18, with no hospital mortality and two late deaths (congestive failure and ventricular tachyarrhythmia at 7 months, ventricular tachyarrhythmia at 5 months); eight of 16 survivors have PVCs. Acute (< 3 weeks) infarct resection was performed in six patients with three hospital deaths, no late deaths; one survivor has PVCs. Chronic (> 3 weeks) aneurysm resection in four patients (with bypass grafting in three) had no operative mortality, one late death (5 months) from ventricular tachyarrhythmias, and one survivor continues with PVCs. The remaining seven patients, all in cardiogenic shock, required more than two procedures (bypass grafting, LV resection, VSD closure, mitral valve replacement), with five hospital deaths; the two survivors still have PVCs. Thus, ventricular tachyarrhythmia secondary to coronary artery disease is more likely to resolve postoperatively in patients without myocardial infarction, but its postoperative persistence remains substantial and may warrant special efforts to locate and ablate ectopic foci and/or re-entry pathways.
我们对51例冠心病患者进行了为期32个月的研究，以确定冠状动脉血运重建或心室切除术对室性快速性心律失常的影响。这些患者手术的主要指征是快速性心律失常，手术死亡率为18%（9/51）。16例患者未记录到心肌梗死，其中4例为心脏骤停后复苏成功；15例行冠状动脉搭桥术，1例行冠状动脉搭桥术和二尖瓣置换术，有1例住院死亡。15名幸存者中有4例仍有室性早搏（PVC）；所有心脏骤停患者均无PVC。其他35例患者有心肌梗死记录，其中19例伴有心脏骤停。仅行搭桥术的有18例，无住院死亡，2例晚期死亡（1例于术后7个月死于充血性心力衰竭和室性快速性心律失常，1例于术后5个月死于室性快速性心律失常）；16名幸存者中有8例有PVC。6例急性（<3周）梗死切除术患者中有3例住院死亡，无晚期死亡；1例幸存者有PVC。4例慢性（>3周）动脉瘤切除术患者（3例同时行搭桥术）无手术死亡，1例晚期死亡（术后5个月死于室性快速性心律失常），1例幸存者仍有PVC。其余7例患者均处于心源性休克，需要进行两种以上手术（搭桥术、左心室切除术、室间隔缺损修补术、二尖瓣置换术），5例住院死亡；2例幸存者仍有PVC。因此，冠心病继发的室性快速性心律失常在无心肌梗死的患者术后更有可能缓解，但其术后持续存在的情况仍然很严重，可能需要特别努力寻找并消融异位病灶和/或折返通路。
