Wei Hua, Chai Shoudong, Liu Changcheng, Huang Xinsheng, Gu Chengxiong
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Braz J Cardiovasc Surg. 2019 Mar-Apr;34(2):187-193. doi: 10.21470/1678-9741-2018-0366.
The study aimed to compare the clinical outcomes of simplified linear plication and classic patch plasty in patients with left ventricular aneurysm (LVA).
We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups.
The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome (P=0.042) with higher proportion of intra-aortic balloon pumping assistance (P=0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay (P<0.001, P<0.001, and P=0.001, respectively). No significant difference was found in the long-term survival (P=0.62).
Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option.
本研究旨在比较简化线性折叠术与经典补片成形术治疗左心室室壁瘤（LVA）患者的临床疗效。
我们回顾性分析了2006年至2016年间接受LVA修复术的282例患者。经过倾向评分匹配后，45对接受LVA手术的患者被分为补片组（体外循环下心室内补片成形术）或折叠组（非体外循环下线性折叠术）。然后，比较两组匹配患者的早期手术结果和长期生存率。
两组匹配患者出院时的心功能改善情况相似，但补片组患者比折叠组患者更常出现低心排血量综合征（P = 0.042），主动脉内球囊反搏辅助比例更高（P = 0.034）。与补片组患者相比，折叠组患者在机械通气、重症监护病房住院时间和住院总时间方面的恢复时间更短（分别为P < 0.001、P < 0.001和P = 0.001）。长期生存率无显著差异（P = 0.62）。
非体外循环下线性折叠术在早期结果和长期生存率方面显示出可接受的效果。对于高危患者，简化的LVA修复技术可能是一种选择。
