Macedo Francisco Igor B, Carvalho Enisa M, Hassan Mohammed, Ricci Marco, Gologorsky Edward, Salerno Tomas A
Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida 33136, USA.
J Card Surg. 2010 May;25(3):267-71. doi: 10.1111/j.1540-8191.2010.01000.x. Epub 2010 Feb 18.
Patients with very low left ventricular ejection fraction (LVEF) are at high risk for valve surgery. We herein present our experience with beating heart valve surgery in such patients.
From May 2000 to October 2006, 346 consecutive patients underwent beating heart valve surgery. Of these, 50 patients had LVEF <30%: 7 had LVEF 21 to 29%, 34 had LVEF <20%, and 9 had LVEF <10%. Mean age was 57.44 +/- 12.45 years (range 28 to 85 years). There were 40 males (80%) and 10 females (20%).
Isolated mitral valve (MV) and aortic valve replacements were performed in 11 (22%) and 10 (20%) of patients, respectively. Fourteen (28%) patients underwent combined coronary artery bypass grafting and valve replacements. MV repairs were performed; 13 (26%) patients and 2 (4%) patients had combined MV replacements and tricuspid repairs. Mean hospital stay was 15.37 +/- 13.12 days (range 3 to 55 days). Overall early mortality (<30 days) was 6% (three patients) and one patient (2%) died late (>30 days).
Beating heart valve surgery in patients with poor LVEF yields results similar to conventional surgery using cardioplegia. Additional studies are needed to fully evaluate the potential benefits of this method of myocardial perfusion for this high-risk group of patients.
左心室射血分数（LVEF）极低的患者进行瓣膜手术的风险很高。我们在此介绍我们在这类患者中进行心脏不停跳瓣膜手术的经验。
从2000年5月至2006年10月，346例连续患者接受了心脏不停跳瓣膜手术。其中，50例患者的LVEF<30%：7例患者的LVEF为21%至29%，34例患者的LVEF<20%，9例患者的LVEF<10%。平均年龄为57.44±12.45岁（范围为28至85岁）。男性40例（80%），女性10例（20%）。
分别有11例（22%）和10例（20%）患者进行了单纯二尖瓣（MV）置换和主动脉瓣置换。14例（28%）患者接受了冠状动脉旁路移植术和瓣膜置换联合手术。进行了MV修复；13例（26%）患者和2例（4%）患者进行了MV置换和三尖瓣修复联合手术。平均住院时间为15.37±13.12天（范围为3至55天）。总体早期死亡率（<30天）为6%（3例患者），1例患者（2%）晚期（>30天）死亡。
LVEF较差的患者进行心脏不停跳瓣膜手术的结果与使用心脏停搏液的传统手术相似。需要进一步研究以全面评估这种心肌灌注方法对这一高危患者群体的潜在益处。
