心室内环形补片修补术后左心室容积变化及心脏事件的预测因素

Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty.

作者信息

Kokaji Kiyokazu, Shin Hankei, Hotoda Kentaro, Mori Mitsuharu, Kumamaru Hiroya, Yozu Ryohei

机构信息

Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.

出版信息

Jpn J Thorac Cardiovasc Surg. 2004 Dec;52(12):551-9. doi: 10.1007/s11748-004-0022-2.

DOI:10.1007/s11748-004-0022-2

PMID:15651400

Abstract

OBJECTIVE

The aim of this study was to identify predictors of cardiac events after endoventricular circular patch plasty (Dor operation) by analyzing our experience with Dor operation.

METHODS

Thirty patients with left ventricular aneurysm and/or ischemic cardiomyopathy who underwent Dor operation were included in this study. Hemodynamic and clinical results were analyzed, and the predictors of cardiac events were examined.

RESULTS

Hospital mortality was 3.3%. Postoperative clinical status and left ventricular (LV) function in all survivors significantly improved. The survival rates at 1, 3, and 5 years after operation were 93%, 89% and 89%. The corresponding cardiac event-free rates were 75%, 67% and 49%. Pre- and postoperative LV function and volume did not differ significantly between patients with or without cardiac events. However, the proportion of reduced end-diastolic volume index (EDVI) (preoperative EDVI-postoperative EDVI) to preoperative EDVI was significantly higher in patients with cardiac events than in cardiac event-free patients. Postoperative LV volume re-increased in the cases with cardiac events during follow-up. Cox regression analysis confirmed that preoperative clinical premature ventricular contraction and end-systolic volume index (ESVI), postoperative EDVI, ESVI, and ejection fraction were independent predictors of late cardiac events. There was a significant positive correlation between preoperative ESVI and postoperative EDVI.

CONCLUSION

Though LV function significantly improved after Dor operation, LV reconstruction with excessive reduction can cause restarting LV remodeling and increasing mortality and morbidity. Therefore, LV reconstruction of appropriate sizes and shapes, considering the function of residual myocardium, has a significant effect on prognosis. It is highly reasonable to expect that preoperative ESVI can predict the optimal size of reconstructed left ventricle.

摘要

目的

本研究旨在通过分析我们进行心室内环形补片成形术（Dor手术）的经验，确定术后心脏事件的预测因素。

方法

本研究纳入了30例行Dor手术的左心室室壁瘤和/或缺血性心肌病患者。分析血流动力学和临床结果，并检查心脏事件的预测因素。

结果

医院死亡率为3.3%。所有存活患者的术后临床状况和左心室（LV）功能均显著改善。术后1年、3年和5年的生存率分别为93%、89%和89%。相应的无心脏事件发生率分别为75%、67%和49%。发生或未发生心脏事件的患者术前和术后LV功能及容积无显著差异。然而，发生心脏事件的患者舒张末期容积指数（EDVI）降低（术前EDVI-术后EDVI）占术前EDVI的比例显著高于未发生心脏事件的患者。随访期间发生心脏事件的病例术后LV容积再次增加。Cox回归分析证实，术前临床室性早搏和收缩末期容积指数（ESVI）、术后EDVI、ESVI及射血分数是晚期心脏事件的独立预测因素。术前ESVI与术后EDVI之间存在显著正相关。