Marchenko Andrey, Chernyavsky Alexander, Efendiev Vidady, Volokitina Tanya, Karaskov Alexander
Department of Aortic and Coronary Artery Surgery, Research Institute of Circulation Pathology, Novosibirsk, Russia.
Interact Cardiovasc Thorac Surg. 2011 Jul;13(1):46-51. doi: 10.1510/icvts.2010.253716. Epub 2011 Mar 14.
In this study, we included 236 patients with ischemic heart failure and ejection fraction (EF) <35% who underwent surgical treatment. Patients were randomized in two groups. There were 116 patients who underwent coronary artery bypass grafting (CABG) with surgical ventricular reconstruction (SVR) and 120 patients who underwent CABG alone. The hospital mortality rate was 5.8% after isolated CABG and 3.5% after CABG combined with SVR. All survivors had follow-up investigation from four months to five years, with a mean follow-up time of 31±13 months. The mean New York Heart Association (NYHA) functional class decreased from 2.9±0.5 to 2.2±0.7 one year after CABG and from 3.1±0.4 to 2.0±0.6 one year after CABG with SVR. We showed that left ventricular reconstruction significantly decreased EDV from 237±52 to 176±30 and correspondingly increased EF from 32±6 to 39±9. However, after isolated CABG EF did not increase significantly (32±7 preoperatively and 34±11 postoperatively). One- and three-year rates were 95% and 78% after SVR with CABG and 83% and 78% after CABG alone. Despite the more aggressive surgical strategy, left ventricular reconstruction did not increase operative mortality and early results were significantly effective compared with coronary artery bypass grafting alone.
在本研究中，我们纳入了236例接受手术治疗的缺血性心力衰竭且射血分数（EF）<35%的患者。患者被随机分为两组。116例患者接受了冠状动脉旁路移植术（CABG）联合手术性心室重建（SVR），120例患者仅接受了CABG。单纯CABG后的医院死亡率为5.8%，CABG联合SVR后的医院死亡率为3.5%。所有幸存者均接受了4个月至5年的随访，平均随访时间为31±13个月。冠状动脉旁路移植术后1年，纽约心脏协会（NYHA）功能分级平均从2.9±0.5降至2.2±0.7；冠状动脉旁路移植术联合手术性心室重建术后1年，NYHA功能分级平均从3.1±0.4降至2.0±0.6。我们发现，左心室重建显著降低了舒张末期容积（EDV），从237±52降至176±30，并相应地将射血分数从32±6提高到39±9。然而，单纯冠状动脉旁路移植术后射血分数没有显著增加（术前32±7，术后34±11）。冠状动脉旁路移植术联合手术性心室重建术后1年和3年的生存率分别为95%和78%，单纯冠状动脉旁路移植术后分别为83%和78%。尽管采用了更积极的手术策略，但与单纯冠状动脉旁路移植术相比，左心室重建并未增加手术死亡率，早期结果显著有效。
