Nicolini Francesco, Zoffoli Giampaolo, Cagnoni Giovanni, Agostinelli Andrea, Colli Andrea, Fragnito Claudio, Borrello Bruno, Beghi Cesare, Gherli Tiziano
Cardiac Surgery Department, University of Parma, Parma, Italy.
Heart Vessels. 2006 Jan;21(1):28-32. doi: 10.1007/s00380-005-0855-3.
The aim of this study was to examine perioperative mortality and morbidity and midterm results in patients undergoing coronary bypass graft and mitral valve annuloplasty with advanced dilated cardiomyopathy. Sixty-one patients with ischemic dilated cardiomyopathy underwent coronary artery bypass grafting and mitral valve annuloplasty between January 1998 and December 2003. Patients eligible for revascularization that presented a mild or more severe mitral valve regurgitation at echocardiography (effective regurgitant orifice > 0.2 cm(2)) were considered for annuloplasty with a Cosgrove ring. New York Heart Association class (NYHA) III/IV was present in 40 patients (66%) and Canadian Cardiovascular Society class III-IV in 19 (31%). A previous acute myocardial infarction was reported in 48 patients (79%). The mean number of graft anastomoses was 2.5 +/- 0.7 and the left internal mammary artery was used in 49 patients (80%). In-hospital mortality was 4.9% (3 patients), due to unsuccessful weaning from cardiopulmonary bypass, multiple organ failure, and stroke, respectively. Left ventricle ejection fraction improved from 28.9% +/- 5.2% preoperatively to 35.4% +/- 8.1% at follow-up (P = 0.0001) and a significant reduction in NYHA III/IV was detected: from 40 patients preoperatively (66%) to 14 (31%) at follow-up (P = 0.031). Midterm cardiac-related mortality rate was 3.4%. In our experience combined coronary artery bypass grafting and ring annuloplasty for ischemic dilated cardiomyopathy can be performed with acceptable risks for in-hospital mortality and morbidity. Midterm results show a good survival rate and a durable functional improvement in this subset of patients.
本研究的目的是探讨晚期扩张型心肌病患者行冠状动脉搭桥术和二尖瓣瓣环成形术的围手术期死亡率、发病率及中期结果。1998年1月至2003年12月期间，61例缺血性扩张型心肌病患者接受了冠状动脉旁路移植术和二尖瓣瓣环成形术。超声心动图显示有轻度或更严重二尖瓣反流（有效反流口>0.2 cm²）且适合血运重建的患者考虑使用Cosgrove环进行瓣环成形术。40例患者（66%）为纽约心脏协会（NYHA）Ⅲ/Ⅳ级，19例（31%）为加拿大心血管学会Ⅲ - Ⅳ级。48例患者（79%）曾有过急性心肌梗死。平均移植血管吻合数为2.5±0.7，49例患者（80%）使用了左乳内动脉。住院死亡率为4.9%（3例），分别因体外循环脱机失败、多器官功能衰竭和中风。左心室射血分数从术前的28.9%±5.2%提高到随访时的35.4%±8.1%（P = 0.0001），且NYHAⅢ/Ⅳ级患者显著减少：从术前的40例（66%）降至随访时的14例（31%）（P = 0.031）。中期心脏相关死亡率为3.4%。根据我们的经验，对于缺血性扩张型心肌病患者，联合冠状动脉旁路移植术和瓣环成形术可在可接受的住院死亡率和发病率风险下进行。中期结果显示该组患者生存率良好且功能持续改善。
