Soliman Hamad M A, Peels K, Van Straten A, Van Zundert A, Schönberger J
Department of Cardio-Thoracic Surgery, Catharina Hospital Eindhoven, The Netherlands.
Acta Anaesthesiol Belg. 2007;58(1):37-44.
This prospective study evaluates the surgical outcome of 75 consecutive patients with impaired left ventricular function, including an analysis of predictors of the short-term outcome following coronary artery bypass grafting (CABG). Seventy-five patients (mean age 64 +/- 13 years) with coronary artery disease and impaired left ventricular function (left ventricular ejection fraction [EF] < or = 40%) who underwent a coronary artery bypass surgery were prospectively studied. Echocardiography and thallium-201 myocardial scintigraphy were preoperatively performed to measure the left ventricular function and to assess myocardial viability. Postoperative echocardiography was done before discharge and six months later to evaluate recovery of left ventricular function. Five patients (6.7%) died in total: three deaths were cardiac related (4%) and two patients (2.7%) died due to other causes. The left ventricular ejection fraction improved immediately after the operation (from 32.2 +/- 6% to 39.5 +/- 8%, p = 0.01) and showed a sustained improvement at later follow-up (mean = 16.3 +/- 4.5 months) (44.0 +/- 4.0%, p = 0.01). The left ventricular wall motion score improved significantly only at later follow-up (from 12.2 +/- 1.8 to 9.4 +/- 2.0, p = 0.03). In 43 patients of whom a preoperative thallium-201 scintigraphy was available, the presence of extensive reversible defects was correlated with significant improvement in EF. On the other hand, a poor outcome was correlated with the presence of pathological Q waves in the preoperative ECG and with an increased left ventricular end-systolic volume index (> 100 ml/m2). Patients with marked left ventricular dysfunction can safely undergo CABG with a low mortality and morbidity. The presence of extensive reversible defects on preoperative thallium-201 scintigraphy is a strong predictor of postoperative recovery of myocardial function. A poor outcome of surgery can be expected in the presence of pathological Q waves on the preoperative ECG or when the left ventricular endsystolic volume index exceeds 100 ml/m2.
这项前瞻性研究评估了75例连续的左心室功能受损患者的手术结果，包括对冠状动脉旁路移植术（CABG）后短期结果的预测因素进行分析。对75例患有冠状动脉疾病且左心室功能受损（左心室射血分数[EF]≤40%）并接受冠状动脉旁路手术的患者进行了前瞻性研究。术前进行了超声心动图和铊-201心肌闪烁显像，以测量左心室功能并评估心肌活力。出院前及术后6个月进行术后超声心动图检查，以评估左心室功能的恢复情况。总共有5例患者（6.7%）死亡：3例死亡与心脏相关（4%），2例患者（2.7%）因其他原因死亡。左心室射血分数在术后立即改善（从32.2±6%提高到39.5±8%，p = 0.01），并在后期随访（平均 = 16.3±4.5个月）时持续改善（44.0±4.0%，p = 0.01）。左心室壁运动评分仅在后期随访时显著改善（从12.2±1.8提高到9.4±2.0，p = 0.03）。在43例术前有铊-201闪烁显像的患者中，广泛可逆性缺损的存在与EF的显著改善相关。另一方面，不良结果与术前心电图中病理性Q波的存在以及左心室收缩末期容积指数增加（>100 ml/m²）相关。左心室功能明显受损的患者可以安全地接受CABG，死亡率和发病率较低。术前铊-201闪烁显像上广泛可逆性缺损的存在是心肌功能术后恢复的有力预测指标。术前心电图出现病理性Q波或左心室收缩末期容积指数超过100 ml/m²时，手术预后可能较差。
