Furukawa Koji, Yano Mitsuhiro, Nakamura Eisaku, Matsuyama Masakazu, Nishimura Masanori, Kawagoe Katsuya, Nakamura Kunihide
Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki, 889-1692, Japan.
Gen Thorac Cardiovasc Surg. 2017 Jul;65(7):381-387. doi: 10.1007/s11748-017-0773-1. Epub 2017 Apr 4.
The impact of surgical ventricular restoration (SVR) on survival and major adverse cardiac events (MACEs) is still controversial. The purposes of this study were to analyze our surgical experience with SVR for ischemic cardiomyopathy and to determine the effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after SVR.
Between April 2010 and May 2016, 19 patients underwent SVR. The mean age was 60 ± 11 years and the mean New York Heart Association functional class was 2.9 ± 0.8. Preoperative mean left ventricular end systolic volume index (LVESVI) and ejection fraction (LVEF) were 134 ± 56 mL/m and 24 ± 7%, respectively. The early-to-late mitral valve flow ratio (E/A) on echocardiogram was 2.4 ± 1.8 and 9 patients had E/A ≥2, excluding 2 patients with atrial fibrillation. The mean follow-up period was 29 ± 16 months. One patient died of heart failure at 6 months postoperative; the overall survival rate at 3 years was 95%. MACEs requiring hospitalization occurred in 10 patients; E/A ≥2, or restrictive filling pattern, was the only significant predictor of MACE in multivariate analysis. Reverse remodeling was associated with E/A <2, but not E/A ≥2. There was also a significant difference between patients with E/A <2 vs. ≥2 with respect to MACE-free survival rates at 3 years (100 vs. 10%; p = 0.001).
The degree of preoperative diastolic dysfunction can influence the outcome after SVR. Patients with E/A ≥2 may not be good candidates for SVR.
外科心室修复术（SVR）对生存率和主要不良心脏事件（MACE）的影响仍存在争议。本研究的目的是分析我们对缺血性心肌病进行SVR的手术经验，并确定术前左心室舒张功能障碍对SVR术后中期结局的影响。
2010年4月至2016年5月期间，19例患者接受了SVR。平均年龄为60±11岁，平均纽约心脏协会心功能分级为2.9±0.8。术前平均左心室收缩末期容积指数（LVESVI）和射血分数（LVEF）分别为134±56 mL/m²和24±7%。超声心动图上二尖瓣早期与晚期血流比值（E/A）为2.4±1.8，9例患者E/A≥2，排除2例心房颤动患者。平均随访期为29±16个月。1例患者术后6个月死于心力衰竭；3年总生存率为95%。10例患者发生需要住院治疗的MACE；E/A≥2或限制性充盈模式是多变量分析中MACE的唯一显著预测因素。逆向重构与E/A<2相关，但与E/A≥2无关。E/A<2与≥2的患者在3年无MACE生存率方面也存在显著差异（100%对10%；p = 0.001）。
术前舒张功能障碍的程度可影响SVR术后的结局。E/A≥2的患者可能不是SVR的合适候选者。
