Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Chin Med J (Engl). 2012 Sep;125(18):3228-35.
The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.
From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.
Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0).
The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.
不停跳心尖前侧壁动脉瘤折叠术的时间反应尚未得到很好的定义。我们评估了该技术的长期临床和功能结果，并将其疗效与补片模型修复进行了比较。
从 2005 年 3 月至 2010 年 5 月，连续 163 例（男 115 例，女 48 例）因梗死后左心室瘤（LVA）接受手术治疗，54 例行补片成形术（A 组），109 例行非体外循环心尖前侧壁动脉瘤折叠术（B 组）。所有患者均同时进行冠状动脉血运重建，其他手术包括隔瓣切开术 8 例，室性心动过速消融术 6 例。随访时间为 1 至 5 年，评估短期和中期结局，包括并发症、心功能和死亡率。
所有患者的早期死亡率为 1.8%（A 组 1 例死亡，B 组 2 例死亡，无统计学意义[NS]）。围手术期支持包括主动脉内球囊泵 16 例（9.8%）（A 组 6 例，B 组 10 例，NS）和正性肌力药物 84 例（51.5%）（A 组 34 例，B 组 50 例，NS）。在平均（3.7±0.8）年的随访中，8 例患者死亡，其中 4 例与心脏相关。无患者需要移植，2 例需要使用植入式心脏复律除颤器治疗室性心动过速。1 年和 5 年的生存率分别为 95%和 86%，两组间无显著差异。中期存活者的心功能分级从 2.90±0.59 改善至 1.65±0.54（P<0.001），两组间无显著差异。死亡或心功能不良的术前危险因素为射血分数（EF）<0.35（OR=7.9，95%CI 1.6-40.0）；充血性心力衰竭（CHF）（OR=4.4，95%CI 1.0-19.0）；左室收缩末期容积指数（ESVI）>80ml/m2（OR=3.7，95%CI 1.0-14.0）；年龄>70 岁（OR=2.4，95%CI 1.0-12.0）。
与冠状动脉搭桥术相关的非体外循环心尖前侧壁动脉瘤折叠术可在较低的手术死亡率下进行，可提供良好的症状缓解和长期生存，补片模型修复的疗效相似。
