Sule Anupam A, Sule Ajey A, Fred Downey H, Thakur Sanjeev S
Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Texas, USA.
Indian J Surg. 2010 Feb;72(1):20-6. doi: 10.1007/s12262-010-0004-9. Epub 2010 Feb 5.
Severe heart failure refractory to medical treatment necessitates the use of other modalities of treatment. Surgical ventricular restoration (SVR) surgery can provide relief until donour hearts are available or when transplantation is contraindicated. In this review we look at the physiological basis for improvement in cardiac function and cardiac and haemodynamic changes that occur after SVR. We also compile the reported factors affecting surgical outcome, criteria for patient selection and predictors of postoperative mortality. NYHA class, presence of diastolic failure, severe impairment of contractile function and presence of mitral regurgitation were the most important determinants. Various different procedures for achieving SVR are briefly discussed. Importance of mitral valve repair/replacement, coronary artery bypass grafting and intraoperative echocardiography in improving postoperative result is highlighted. Role of perioperative medication (anti-arrhythmics, ACE inhibitors and β-blockers) is briefly studied at the end of the review.
药物治疗无效的严重心力衰竭需要采用其他治疗方式。手术性心室修复（SVR）手术可以在有供体心脏可用或移植禁忌时提供缓解。在本综述中，我们探讨了SVR术后心脏功能改善的生理基础以及发生的心脏和血流动力学变化。我们还汇总了报道的影响手术结果的因素、患者选择标准和术后死亡率的预测因素。纽约心脏协会（NYHA）心功能分级、舒张性心力衰竭的存在、收缩功能严重受损和二尖瓣反流的存在是最重要的决定因素。简要讨论了实现SVR的各种不同手术方法。强调了二尖瓣修复/置换、冠状动脉旁路移植术和术中超声心动图在改善术后结果中的重要性。综述结尾简要研究了围手术期药物（抗心律失常药、血管紧张素转换酶抑制剂和β受体阻滞剂）的作用。
