Soliman Hamad Mohamed A, Tan M Erwin S H, van Straten Albert H M, van Zundert André A J, Schönberger Jacques P A M
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Ann Thorac Surg. 2008 Feb;85(2):488-93. doi: 10.1016/j.athoracsur.2007.09.010.
In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction.
Between 1997 and 1998, 75 consecutive patients with moderate to severe left ventricular dysfunction underwent coronary artery bypass grafting procedures. The operative mortality rate was 4.0%, and the 72 survivors were monitored for 8 years. The end points were mortality, symptomatic status (New York Heart Association [NYHA] functional class), and left ventricular function.
The total survival rate after 8 years was 89.3%. During follow-up, 8 patients died. Death was attributed to a cardiac cause in 5 patients and to a noncardiac cause in 3. There was no statistically significant difference between preoperative and late postoperative NYHA functional class, despite a statistically significant improvement that persisted for up to 4 years after CABG. The results of echocardiography showed a statistically significant improvement in the left ventricular ejection fraction (from 0.322 +/- 0.06 preoperatively to 0.463 +/- 0.02 at follow-up, p < 0.001). Multivariate analysis revealed that the left ventricular end-systolic volume index, the presence of angina pectoris, and absence of symptoms of congestive heart failure were preoperative indicators of freedom from heart failure after coronary operations (p < 0.05).
Coronary artery bypass grafting for patients with moderate-to-severe left ventricular dysfunction is associated with acceptable long-term results. The left ventricular end-systolic volume index is a simple noninvasive method to aid in the preoperative decision making in such patients.
在这项前瞻性研究中，我们调查了左心室射血分数中度至重度降低的患者冠状动脉搭桥术后长期预后、症状及左心室功能的决定因素。
1997年至1998年期间，75例连续的中度至重度左心室功能障碍患者接受了冠状动脉搭桥手术。手术死亡率为4.0%，72名幸存者接受了8年的监测。终点指标为死亡率、症状状态（纽约心脏协会[NYHA]功能分级）和左心室功能。
8年后的总生存率为89.3%。随访期间，8例患者死亡。5例患者死于心脏原因，3例死于非心脏原因。尽管冠状动脉搭桥术后长达4年存在统计学上的显著改善，但术前与术后晚期NYHA功能分级之间无统计学显著差异。超声心动图结果显示左心室射血分数有统计学上的显著改善（术前为0.322±0.06，随访时为0.463±0.02，p<0.001）。多变量分析显示，左心室收缩末期容积指数、心绞痛的存在以及无充血性心力衰竭症状是冠状动脉手术后无心力衰竭的术前指标（p<0.05）。
中度至重度左心室功能障碍患者的冠状动脉搭桥手术具有可接受的长期结果。左心室收缩末期容积指数是一种简单的非侵入性方法，有助于对此类患者进行术前决策。
