Isomura Tadashi, Hirota Masanori, Notomi Yuichi, Hoshino Joji, Kondo Taichi, Takahashi Yu, Yoshida Minoru
Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan.
Interact Cardiovasc Thorac Surg. 2015 Jun;20(6):725-31; discussion 731. doi: 10.1093/icvts/ivv019. Epub 2015 Mar 3.
Non-transplant surgery for dilated cardiomyopathy (DCM) has been in the process of development. We performed posterior restoration for dilated akinetic or dyskinetic lesions in patients with DCM and obtained favourable outcomes. The early and long-term results of the procedures are discussed.
Between 2005 and 2013, posterior restoration procedures (PRPs) for DCM were electively performed in 58 patients (17 with ischaemic and 41 with non-ischaemic DCM). There were 45 men and 13 women with a mean age of 56 ± 12 years old. The mean preoperative ejection fraction was 24% and the preoperative New York Heart Association functional class was Class III in 24 and Class IV in 34 patients with intravenous inotrope support. Indications for PRPs were determined by using speckle-tracking echocardiography of the posterior region of the left ventricle before surgery (GE ultrasound machine, Vivid 7 or Vivid E9). After cardioplegic arrest, mitral surgery or coronary artery bypass grafting (CABG) was performed and the posterior left ventricular (LV) muscle between bilateral papillary muscles was incised or resected. The LV apex was preserved and cryoablation was applied between the cut edge and the posterior mitral annulus. All patients were followed up by transthoracic echocardiography.
In addition to PRP, mitral surgery was performed in 56 (plasty 51, replacement 5), tricuspid annuloplasty in 21, CABG in 17, cardiac resynchronization therapy in 6 and LV lead implantation in 27 patients. Perioperative intra-aortic balloon pumping was used in 9 patients and there was no hospital mortality. After the operation, 35 patients (60%) improved their functional class to Class I or II. In the late follow-up, there were 14 cardiac deaths (congestive heart failure 10, ventricular arrhythmia 4). The 3- and 8-year survival rates were 77 or 66%, respectively.
DCM with posterior akinesis or dyskinesis indicated by speckle-tracking echocardiography can be surgically treated with PRP. Our results demonstrated that 60% of the selected patients could avoid heart transplantation with relief of their symptoms.
扩张型心肌病（DCM）的非移植手术一直在发展过程中。我们对DCM患者的扩张性运动减弱或运动障碍性病变进行了后修复手术，并取得了良好的效果。本文讨论了该手术的早期和长期结果。
2005年至2013年期间，对58例患者（17例缺血性DCM和41例非缺血性DCM）选择性地进行了DCM的后修复手术（PRP）。其中男性45例，女性13例，平均年龄56±12岁。术前平均射血分数为24%，术前纽约心脏协会心功能分级：24例为Ⅲ级，34例在静脉使用血管活性药物支持下为Ⅳ级。PRP的适应症通过术前使用左心室后壁的斑点追踪超声心动图（GE超声仪，Vivid 7或Vivid E9）来确定。心脏停搏后，进行二尖瓣手术或冠状动脉旁路移植术（CABG），并切开或切除双侧乳头肌之间的左心室（LV）后壁肌肉。保留LV尖，并在切口边缘与二尖瓣后瓣环之间进行冷冻消融。所有患者均接受经胸超声心动图随访。
除PRP外，56例患者进行了二尖瓣手术（成形术51例，置换术5例），21例进行了三尖瓣环成形术，17例进行了CABG，6例进行了心脏再同步治疗，27例进行了LV导联植入。9例患者围手术期使用了主动脉内球囊泵，无医院死亡病例。术后，35例患者（60%）的心功能分级改善为Ⅰ级或Ⅱ级。在晚期随访中，有14例心脏死亡（充血性心力衰竭10例，室性心律失常4例）。3年和8年生存率分别为77%和66%。
斑点追踪超声心动图显示有后壁运动减弱或运动障碍的DCM可以通过PRP进行手术治疗。我们的结果表明，60%的选定患者可以避免心脏移植并缓解症状。
