心肌梗死后左心室前壁瘤患者行外科心室修复和冠状动脉旁路移植术后的长期结果。

Long-term outcomes after surgical ventricular restoration and coronary artery bypass grafting in patients with postinfarction left ventricular anterior aneurysm.

机构信息

Department of Cardiac Surgery, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2010 Feb;11(2):96-102. doi: 10.2459/JCM.0b013e32832f9fc1.

DOI:10.2459/JCM.0b013e32832f9fc1

PMID:19952949

Abstract

OBJECTIVE

Surgical ventricular restoration (SVR) for postinfarction left ventricular anterior aneurysm improves left ventricular function. The aim of this study was to evaluate whether concomitant multivessel coronary artery disease (MVCAD) can affect long-term outcome. Thus, long-term results of SVR associated with multiple coronary artery bypass grafting (CABG) for MVCAD (group 1) were compared with SVR with or without CABG to left anterior descending artery and/or its diagonal branch for single-vessel coronary artery disease (group 2).

METHODS

Data from 104 consecutive patients (age 64 +/- 8 years) with left ventricular anterior aneurysm, subjected to SVR from January 1994 to December 2004 and divided into group 1 (n = 79) and group 2 (n = 25), were analyzed.

RESULTS

In group 1 vs. group 2, number of grafts/patient (2.7 +/- 0.9 vs. 0.6 +/- 0.6, P < 0.0001) was higher, cardiopulmonary bypass (109 +/- 30 vs. 65 +/- 28 min, P < 0.0001) and aortic cross-clamp times (65 +/- 18 vs. 44 +/- 23 min, P < 0.0001) were longer, resected aneurysmatic area (12 +/- 8 vs. 17 +/- 11 cm2, P < 0.05) was smaller. Operative mortality was 3.7 vs. 4% (P = not significant). At 12 years, survival (85 +/- 5 vs. 80 +/- 16%) and freedom from cardiac events (70 +/- 7 vs. 75 +/- 16%) were not statistically different in both groups. Follow-up echocardiography showed significant left ventricular ejection fraction improvement in group 1 (0.45 +/- 0.07 vs. 0.34 +/- 0.10 preoperatively, P < 0.0001) and group 2 (0.47 +/- 0.09 vs. 0.36 +/- 0.12, P = 0.001). Independent predictors of late death were preoperative history of ventricular arrhythmias (P < 0.001) and hypo/akinesia of proximal myocardial anterior wall (P < 0.05).

CONCLUSION

Late survival and freedom from cardiac events are excellent after SVR, also when concomitant MVCAD requires complete revascularization. Ventricular arrhythmias and impaired left ventricular anterior wall function are predictors of worse outcome.

摘要

目的

外科心室修复术（SVR）治疗心肌梗死后左心室前壁瘤可改善左心室功能。本研究旨在评估同时合并多支冠状动脉疾病（MVCAD）是否会影响长期预后。因此，比较了多支冠状动脉旁路移植术（CABG）治疗 MVCAD （组 1）与单纯行前降支和/或对角支 CABG 治疗单支冠状动脉疾病（组 2）患者 SVR 的长期结果。

方法

分析了 1994 年 1 月至 2004 年 12 月期间连续 104 例左心室前壁瘤患者（年龄 64 ± 8 岁）的资料，这些患者接受了 SVR 治疗，并分为组 1（n = 79）和组 2（n = 25）。

结果

与组 2 相比，组 1 的每例患者搭桥数（2.7 ± 0.9 vs. 0.6 ± 0.6，P < 0.0001）、体外循环时间（109 ± 30 vs. 65 ± 28 min，P < 0.0001）和主动脉阻断时间（65 ± 18 vs. 44 ± 23 min，P < 0.0001）均更长，切除的动脉瘤面积（12 ± 8 vs. 17 ± 11 cm2，P < 0.05）更小。手术死亡率为 3.7% vs. 4%（P = 无显著差异）。12 年时，两组的存活率（85 ± 5% vs. 80 ± 16%）和无心脏事件生存率（70 ± 7% vs. 75 ± 16%）无统计学差异。随访超声心动图显示，组 1（0.45 ± 0.07 比 0.34 ± 0.10，术前，P < 0.0001）和组 2（0.47 ± 0.09 比 0.36 ± 0.12，P = 0.001）的左心室射血分数均有显著改善。晚期死亡的独立预测因素为术前室性心律失常史（P < 0.001）和近端前壁心肌低运动/无运动（P < 0.05）。