McGiffin D C, Kirklin J K, Plumb V J, Blackstone E H, Waldo A L, Kirklin J W, Karp R B
Department of Surgery, University of Alabama at Birmingham School of Medicine and Medical Center 35294.
Circulation. 1987 Nov;76(5 Pt 2):V93-103.
Among 123 patients undergoing a direct operation, with or without other cardiac surgical procedures, for life-threatening ventricular tachycardia as a complication of ischemic heart disease, 68% of surviving patients were free of the return of ventricular tachycardia or sudden death 2 years after operation and 55% were free of these events at 5 years. The instantaneous risk (hazard function) of these events was highest immediately after operation and declined rapidly, so that by 3 months after operation instantaneous risk had merged with the constant-hazard phase which persisted as long as the patients were followed. More advanced impairment of left ventricular structure and function (with the exception of left ventricular aneurysm) increased the risk of occurrence of these events. Among patients with a negative electrophysiologic study (EPS) at hospital discharge, freedom from recurrent ventricular tachycardia or sudden death was 85% at 3 years. Survival, taking into account hospital deaths, was 54% 2 years after operation and 33% at 5 years. Most commonly (65% of instances) death was a result of acute, subacute, or chronic heart failure. The use of the technique of encircling endocardial myotomy increased the risk of death. Survival was particularly poor after the return of ventricular tachycardia. Direct operations for ventricular tachycardia are most likely to succeed in the presence of a discrete left ventricular aneurysm. The results are particularly unfavorable when there is severe global left ventricular dysfunction and no aneurysm. Improved myocardial protection during operation, and more specifically EPS-guided operations, may reduce the early risk of death and of return of ventricular tachycardia. The late return of ventricular tachycardia may be more related to a progressive secondary left ventricular cardiomyopathy than to an inadequate operation.
在123例因缺血性心脏病并发症出现危及生命的室性心动过速而接受直接手术（无论是否合并其他心脏外科手术）的患者中，68%的存活患者术后2年未出现室性心动过速复发或猝死，55%的患者在5年时未出现这些事件。这些事件的即时风险（风险函数）在术后即刻最高，随后迅速下降，因此到术后3个月时，即时风险已进入持续至随访期的恒定风险阶段。左心室结构和功能的更严重损害（左心室室壁瘤除外）会增加这些事件的发生风险。出院时电生理检查（EPS）结果为阴性的患者中，3年时无室性心动过速复发或猝死的比例为85%。将住院死亡考虑在内，术后2年生存率为54%，5年时为33%。最常见的情况（65%）是死亡由急性、亚急性或慢性心力衰竭导致。采用心内膜环行肌切开术会增加死亡风险。室性心动过速复发后的生存率尤其低。对于室性心动过速的直接手术在存在孤立性左心室室壁瘤的情况下最有可能成功。当存在严重的左心室整体功能障碍且无室壁瘤时，结果尤其不理想。术中改善心肌保护，更具体地说是EPS指导下的手术，可能会降低早期死亡和室性心动过速复发的风险。室性心动过速的晚期复发可能更多地与进行性继发性左心室心肌病有关，而非手术不充分。
