Matthias Bechtel J F, Tölg Ralph, Graf Bernhardt, Richardt Gert, Noetzold Axel, Kraatz Ernst G, Sievers Hans-Hinrich, Bartels Claus
Department for Cardiac Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany.
Eur J Cardiothorac Surg. 2004 May;25(5):807-11. doi: 10.1016/j.ejcts.2004.01.014.
Sudden death due to ventricular arrhythmias occurs frequently among patients with dilated cardiomyopathy and congestive heart failure (CHF). In patients with left ventricular (LV) aneurysms, LV-aneurysm repair (LVAR) reduces LV-size and ameliorates symptoms of CHF, but the incidence of late sudden death is unknown, especially after LVAR without concomitant anti-arrhythmic therapy.
Between June 1993 and June 1999, 147 patients (70% males; 62+/-9 years) with CHF (median: NYHA III) due to anterior LV-aneurysms underwent LVAR. None of the patients underwent anti-arrhythmic surgical procedures concomitant to LVAR. Ninety percent of the patients had additional myocardial revascularization. Hospital records and laevocardiograms were reviewed, and follow-up information was obtained.
In-hospital mortality was 4.1% (n=6). The median follow-up was 3.7 years (0.1-73.4 months; overall 462 patient-years). At follow-up, the patients had significantly less symptoms than preoperatively (median: NYHA II, P<0.001). Nineteen patients had died (5-year survival rate 78%). Of these late deaths, 84% (n=16) were cardiac-related, among which sudden death was most frequent (n=7). Predictors of sudden death were a bypass graft to the right coronary artery (P=0.0100), ventricular tachyarrhythmias early postoperatively (P=0.0315), and cross-clamp time (P=0.0496).
Although the survival and functional state of most patients were good after LVAR without concomitant anti-arrhythmic surgery, we observed a high incidence of late sudden death, which was-among others-significantly associated with postoperative ventricular tachyarrhythmias. To further improve outcomes, intra- and postoperative anti-arrhythmic therapy is advisable in patients undergoing LVAR.
在扩张型心肌病和充血性心力衰竭（CHF）患者中，室性心律失常导致的猝死很常见。在左心室（LV）室壁瘤患者中，LV室壁瘤修复术（LVAR）可减小左心室大小并改善CHF症状，但晚期猝死的发生率尚不清楚，尤其是在未同时进行抗心律失常治疗的LVAR术后。
1993年6月至1999年6月，147例因左室前壁室壁瘤导致CHF（中位数：纽约心脏协会心功能III级）的患者接受了LVAR。所有患者均未在LVAR同时进行抗心律失常手术。90%的患者还进行了心肌血运重建。回顾了医院记录和左心室造影，并获取了随访信息。
住院死亡率为4.1%（n = 6）。中位随访时间为3.7年（0.1 - 73.4个月；总计462患者年）。随访时，患者的症状比术前明显减轻（中位数：纽约心脏协会心功能II级，P < 0.001）。19例患者死亡（5年生存率78%）。在这些晚期死亡中，84%（n = 16）与心脏相关，其中猝死最为常见（n = 7）。猝死的预测因素为右冠状动脉搭桥术（P = 0.0100）、术后早期室性快速心律失常（P = 0.0315）和主动脉阻断时间（P = 0.0496）。
尽管在未同时进行抗心律失常手术的LVAR术后，大多数患者的生存和功能状态良好，但我们观察到晚期猝死的发生率很高，其中与术后室性快速心律失常显著相关。为进一步改善预后，建议对接受LVAR的患者在术中和术后进行抗心律失常治疗。
