Chen Wei-Yuan, Wu Fei-Yi, Shih Chun-Che, Lai Shiau-Ting, Hsu Chiao-Po
Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Aug;72(8):414-21. doi: 10.1016/S1726-4901(09)70398-3.
Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms.
We retrospectively reviewed the records of 49 patients (mean age, 69.8 +/- 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed.
Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 +/- 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7%, 69.9% and 45.7%, respectively. Functional class improved from 2.51 +/- 0.59 to 1.66 +/- 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class >or= 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 +/- 7.2% to 34.1 +/- 7.9% (p < 0.001) in the patch group, and from 26.3 +/- 9.0% to 32.0 +/- 9.2% in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 +/- 10.1% to 52.0 +/- 7.3% (p = 0.190) in the patch group, but deteriorated from 55.0 +/- 6.3% to 50.3 +/- 8.6% in the linear group (p = 0.029).
These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus.
左心室（LV）动脉瘤的外科修复已开展约50年。然而，最合适的手术方法仍未确定。本研究旨在比较两种既定技术，即线性修复与补片重塑，用于修复运动障碍性LV动脉瘤的疗效。
我们回顾性分析了1996年至2006年间49例（平均年龄69.8±7.3岁）因心肌梗死后运动障碍性LV动脉瘤接受手术的患者记录。31例患者接受补片重塑，18例接受线性修复。评估短期和中期结果，包括并发症、心功能和死亡率。
两组的总体住院手术死亡率、主要并发症和早期血流动力学无显著差异。在平均44.0±34.4个月的随访期间，8例患者死亡，其中4例死于心脏相关原因。1年、5年和10年的精算生存率分别为85.7%、69.9%和45.7%。中期存活者的功能分级从2.51±0.59改善至1.66±0.54（p<0.001），两组间无显著差异。多因素分析确定术前纽约心脏协会（NYHA）功能分级≥3是总体死亡率的独立危险因素（p=0.008）。中期随访显示，补片组的LV射血分数从26.5±7.2%提高至34.1±7.9%（p<0.001），线性组从26.3±9.0%提高至32.0±9.2%（p=0.032）。相比之下，补片组的右心室射血分数从49.4±10.1%提高至52.0±7.3%（p=0.190），而线性组从55.0±6.3%降至50.3±8.6%（p=0.029）。
这些发现表明，除右心室射血分数外，这两种修复技术在短期和中期结果方面具有相似的有效性。我们建议，应根据动脉瘤大小以及瘢痕形成过程累及室间隔和二尖瓣下装置的程度，对每位患者个体化选择LV动脉瘤的修复技术。
