Liu Changcheng, Su Zhaoping, Wang Liangshan, Li Bo, Wang Jin, Yu Yang, Gu Chengxiong
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China.
Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China.
Tex Heart Inst J. 2020 Jun 1;47(3):194-201. doi: 10.14503/THIJ-18-6615.
This retrospective study evaluated the feasibility of surgical endoepicardial linear ablation for ventricular tachycardia in patients with postinfarction left ventricular aneurysm. Sixty-four patients with multivessel coronary artery disease and left ventricular aneurysm but no mural thrombosis of the aneurysm or valve disease were treated at our institution from March 2012 through July 2015. All underwent off-pump coronary artery bypass grafting and left ventricular aneurysm repair by linear plication. Twenty-three patients (35.9%) had ventricular tachycardia and underwent surgical endoepicardial linear ablation on the beating heart guided by epicardial substrate mapping with the Carto 3 system. The remaining 41 patients (64.1%) composed the no-ablation group. The effectiveness of surgical linear ablation in the ablation group was evaluated. Safety and clinical outcomes were evaluated and compared between the groups. The ventricular tachycardia recurrence rate in the ablation group was 17.4% in the immediate postoperative period and 23.8% at last follow-up (39 ± 21 mo). Early (<30-d) mortality rates were 8.7% in the ablation group and 4.9% in the no-ablation group (P=0.41); the respective late mortality rates were 19.1% and 18% (P=0.70). Multivariate Cox regression analysis indicated that preoperatively poor left ventricular function was an independent risk factor for early and late death in both groups. The groups were similar in terms of the need for postoperative mechanical circulatory support, intensive care unit stay, and cumulative survival rate. We conclude that, for carefully selected candidates, surgical endoepicardial linear ablation combined with off-pump coronary artery bypass grafting and left ventricular aneurysm linear plication is a feasible treatment for ventricular tachycardia with postinfarction left ventricular aneurysm.
这项回顾性研究评估了手术心内膜线性消融术治疗心肌梗死后左心室室壁瘤患者室性心动过速的可行性。2012年3月至2015年7月，我们机构对64例多支冠状动脉疾病和左心室室壁瘤患者进行了治疗，这些患者无室壁瘤壁内血栓形成或瓣膜疾病。所有患者均接受了非体外循环冠状动脉搭桥术和左心室室壁瘤线性折叠修复术。23例（35.9%）患者发生室性心动过速，在Carto 3系统的心外膜基质标测引导下，于跳动心脏上接受了手术心内膜线性消融术。其余41例患者（64.1%）组成非消融组。评估了消融组手术线性消融的有效性。评估并比较了两组的安全性和临床结局。消融组室性心动过速复发率在术后即刻为17.4%，末次随访（39±21个月）时为23.8%。消融组早期（<30天）死亡率为8.7%，非消融组为4.9%（P=0.41）；晚期死亡率分别为19.1%和18%（P=0.70）。多因素Cox回归分析表明，术前左心室功能差是两组早期和晚期死亡的独立危险因素。两组在术后机械循环支持需求、重症监护病房住院时间和累积生存率方面相似。我们得出结论，对于经过仔细挑选的患者，手术心内膜线性消融术联合非体外循环冠状动脉搭桥术和左心室室壁瘤线性折叠术是治疗心肌梗死后左心室室壁瘤合并室性心动过速的一种可行治疗方法。
