O'Neill James O, Starling Randall C, McCarthy Patrick M, Albert Nancy M, Lytle Bruce W, Navia Jose, Young James B, Smedira Nicholas
Department of Cardiovascular Medicine, Cleveland Clinic, Desk 25, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Eur J Cardiothorac Surg. 2006 Nov;30(5):753-9. doi: 10.1016/j.ejcts.2006.07.018. Epub 2006 Oct 4.
Left ventricular reconstruction (LVR) is performed to improve the morphologic structure and function of the heart in patients with heart failure. This procedure has been performed at the Cleveland Clinic Foundation since 1997. We assessed mortality, functional status, and predictors of outcome in these patients.
Data were extracted from multiple prospectively acquired datasets on demographic, clinical, and operative details of 220 consecutive patients who underwent LVR between July 1997 and July 2003, where the indication for surgery was heart failure (of whom 66% had New York Heart Association (NYHA) functional class III or IV symptoms). Mortality, functional status, and postoperative complications were ascertained by reference to the clinical record, social security death index, and by phone contact. Mean preoperative left ventricular ejection fraction (LVEF) was 21.5+/-7.3% and mean left ventricular end-diastolic diameter was 6.4+/-1.0 cm. The mean age was 61.4+/-9.0 years and 80% were male. The majority (86%) of patients underwent concomitant coronary artery bypass grafting and 49% underwent mitral valve surgery.
Thirty-day mortality was 1% and survival at 1, 3, and 5 years was 92%, 90%, and 80%, respectively. Of the survivors for whom data on NYHA functional class were available, 85% were in NYHA functional class I or II. Mortality was predicted by reduced preoperative ejection fraction <20% (unadjusted hazard ratio 1.53, p = 0.02), body mass index < or = 24 kg/m2 (unadjusted hazard ratio 1.69, p = 0.01), QRS duration > or = 130 ms (unadjusted hazard ratio 1.66, p = 0.01) and the requirement for renal replacement therapy postoperatively (unadjusted hazard ratio 3.85, p < 0.01). Mean LVEF improved to 24.7+/-8.86% (p < 0.01) and left ventricular volumes were also significantly reduced.
In selected patients with heart failure, LVR, in conjunction with revascularization and valve surgery, is associated with excellent survival, improved symptoms, and improved LVEF and left ventricular dimensions.
进行左心室重建术（LVR）以改善心力衰竭患者心脏的形态结构和功能。自1997年以来，克利夫兰诊所基金会一直在开展该手术。我们评估了这些患者的死亡率、功能状态及预后预测因素。
从多个前瞻性收集的数据集中提取了1997年7月至2003年7月期间连续220例行LVR患者的人口统计学、临床及手术细节数据，这些患者的手术指征为心力衰竭（其中66%有纽约心脏协会（NYHA）Ⅲ或Ⅳ级症状）。通过查阅临床记录、社会保障死亡指数及电话联系确定死亡率、功能状态及术后并发症。术前平均左心室射血分数（LVEF）为21.5±7.3%，平均左心室舒张末期直径为6.4±1.0 cm。平均年龄为61.4±9.0岁，80%为男性。大多数患者（86%）同时行冠状动脉旁路移植术，49%行二尖瓣手术。
30天死亡率为1%，1年、3年和5年生存率分别为92%、90%和80%。在有NYHA功能分级数据的幸存者中，85%处于NYHAⅠ或Ⅱ级。术前射血分数降低<20%（未调整风险比1.53，p = 0.02）、体重指数≤24 kg/m2（未调整风险比1.69，p = 0.01）、QRS时限≥130 ms（未调整风险比1.66，p = 0.01）及术后需要肾脏替代治疗（未调整风险比3.85，p < 0.01）可预测死亡率。平均LVEF提高到24.7±8.86%（p < 0.01），左心室容积也显著减小。
在选定的心力衰竭患者中，LVR联合血运重建和瓣膜手术可带来良好的生存率、改善症状，并改善LVEF和左心室大小。
