Kokaji Kiyokazu, Okamoto Masahiko, Hotoda Kentaro, Maehara Tadaaki, Kumamaru Hiroya, Koizumi Kiyoshi
Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
Jpn J Thorac Cardiovasc Surg. 2004 Jan;52(1):1-10. doi: 10.1007/s11748-004-0053-8.
We report hemodynamic and clinical results of our series of endoventricular circular patch plasty (Dor operation) and consider some advantages of this procedure for patients with ischemic cardiomyopathy.
Between 1996 and 2001, 23 consecutive patients with left ventricular aneurysm and/ or ischemic cardiomyopathy after myocardial infarction who underwent Dor operation were included in this study. Hemodynamic and clinical results of Dor operation were analyzed periodically. Patients were divided into two groups according to the extent of asynergy, more than 60% or not, i.e., an ischemic cardiomyopathy group (ICM group) or a simple left ventricular aneurysm group (sLVA group).
Hospital mortality was 4.4%. Postoperative New York Heart Association functional class was improved in all survivors to class I or II. Postoperative ejection fraction (EF) increased and postoperative left ventricular (LV) volume decreased in all survivors. In both groups, early and 1 year postoperative EF increased significantly. Additionally, end-diastolic and end-systolic volumes decreased significantly in the early postoperative period. Postoperative LV volume had re-enlarged in the cases in which preoperative left ventricular end-systolic volume index was more than 90 mL/m2, though left ventricular ejection fraction was maintained or rather improved at 1 year postoperatively. The survival rates after 3 years of the operation in the sLVA and ICM groups were 85.7% and 81.3%.
Though patients with ischemic cardiomyopathy with severe LV dysfunction may benefit the most from Dor operation, postoperative LV re-dilatation may deteriorate late mortality. At operation, whether optimal LV size and shape can be reconstructed and the timing of operation are the important issues because they affect prognoses.
我们报告了一系列心室内环形补片成形术（Dor手术）的血流动力学和临床结果，并探讨了该手术对缺血性心肌病患者的一些优势。
1996年至2001年期间，本研究纳入了23例连续接受Dor手术的心肌梗死后左心室室壁瘤和/或缺血性心肌病患者。定期分析Dor手术的血流动力学和临床结果。根据心肌运动不协调程度将患者分为两组，即超过60%或未超过60%，分别为缺血性心肌病组（ICM组）和单纯左心室室壁瘤组（sLVA组）。
住院死亡率为4.4%。所有存活患者术后纽约心脏协会心功能分级均改善为I级或II级。所有存活患者术后射血分数（EF）增加，左心室（LV）容积减小。两组患者术后早期和术后1年EF均显著增加。此外，术后早期舒张末期和收缩末期容积显著减小。术前左心室收缩末期容积指数超过90 mL/m2的患者，术后左心室容积虽有再增大，但术后1年左心室射血分数保持或有所改善。sLVA组和ICM组术后3年生存率分别为85.7%和81.3%。
尽管重度左心室功能不全的缺血性心肌病患者可能从Dor手术中获益最大，但术后左心室再扩张可能会使晚期死亡率恶化。手术时，能否重建最佳的左心室大小和形状以及手术时机是重要问题，因为它们会影响预后。
