Contreras Carlos Alberto Méndez, Orellana Pedro Xavier, Almeida Antonio Flávio Sanchez de, Finger Marco Aurélio, Rossi João Manoel, Chaccur Paulo
Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Braz J Cardiovasc Surg. 2019 Jun 1;34(3):265-270. doi: 10.21470/1678-9741-2018-0087.
To report our center's experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival.
Observational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival.
Overall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P≤0.01; hazard ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS mortality/morbidity score mean value was 18.14, P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical techniques showed no difference in survival among Dor 81% vs. Jatene 91.7%.
Surgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.
报告我们中心在心室重建手术治疗方面的经验，这是一种有效且高效的技术，可使缺血性病因的终末期心力衰竭患者临床症状改善并提高生存率。
观察性、临床手术、序贯、回顾性研究。2010年1月至2016年12月期间，在但丁·帕扎内塞心脏病学研究所的心力衰竭、心室功能障碍及心脏移植门诊就诊的缺血性心肌病和左心室室壁瘤患者。收集了34例患者的数据，包括系统性动脉高血压、射血分数、纽约心脏协会（NYHA）功能分级（FC）、欧洲心脏手术风险评估系统（EuroSCORE）II值、胸外科医师协会（STS）评分、心室重建技术及生存率。
总死亡率为14.7%，住院死亡率为8.82%，晚期死亡率为5.88%。五年总生存率为85.3%。术前，NYHA FC分级为I级的有5例，II级的有18例，III级的有8例，IV级的有3例；术后NYHA FC分级为I级的有17例，II级的有8例，III级的有6例，IV级的有3例。EuroSCORE II平均值为6.29，P≤0.01；风险比（HR）为1.16（95%置信区间[CI]为1.02 - 1.31）。STS死亡率/发病率评分平均值为18.14，P≤0.004；HR为1.19（95%CI为1.05 - 1.33）。手术技术方面，Dor术式的生存率为81%，Jatene术式的生存率为91.7%，二者无差异。
心脏移植候选者的左心室重建手术治疗有效、高效且安全，能提供足够的生存率。
