Ostermeyer J, Borggrefe M, Breithardt G, Podczek A, Goldmann A, Schoenen J D, Kolvenbach R, Godehardt E, Kirklin J W, Blackstone E H
Chirurgische Universitätsklinik B, Düsseldorf, Federal Republic of Germany.
J Thorac Cardiovasc Surg. 1987 Dec;94(6):848-65.
Between June 1978 and 1986, 93 consecutive patients underwent electrophysiologically guided operations for life-threatening recurrent sustained ventricular tachycardia mostly associated with other surgical procedures, such as left ventricular resection (aneurysmectomy) and coronary artery bypass grafting.
Eighty-seven percent of the surviving patients were free of spontaneous ventricular tachycardia return or sudden death 1 year after the operation and 77% at 5 years. The instantaneous risk of ventricular tachycardia return was highest immediately after operation, declined rapidly, and by 2 weeks postoperatively had merged with the constant hazard phase, which persisted as long as the patients were observed. Endocardial resection, rather than encircling endocardial myotomy, increased the risk of spontaneous ventricular tachycardia return/sudden death. Survival rates, including hospital deaths, were 95% at 30 days, 89% at 1 year, and 70% at 5 years after operation. The most prevalent mode of death was heart failure. The absence of anterolateral left ventricular aneurysms and the use of more extended encircling incisional techniques for ventricular tachycardia ablation increased the risk of early and late death. Survival was particularly poor in that subset of patients in whom recurrent sustained ventricular tachycardia returned after operation; the most prevalent mode of death in this group was also progressive left ventricular failure. Inferences: (1) Complete and partial encircling endocardial myotomy incisions are the most effective surgical techniques for malignant ventricular tachycardia ablation. (2) Because of their adverse effects on left ventricular structure and function, the arrhythmogenic tissues have to be localized as precisely as possible, and the encompassing incisions should be kept as limited as possible. (3) The late return of ventricular tachycardia may be more related to a progressive ischemic left ventricular cardiomyopathy than to an inadequate operation.
1978年6月至1986年期间，93例连续患者接受了电生理引导下的手术，治疗危及生命的复发性持续性室性心动过速，多数与其他外科手术相关，如左心室切除术（动脉瘤切除术）和冠状动脉搭桥术。
87%的存活患者术后1年无自发性室性心动过速复发或猝死，5年时为77%。室性心动过速复发的即时风险在术后即刻最高，迅速下降，术后2周时已进入持续风险期，只要对患者进行观察，该风险期就会持续。心内膜切除术而非环行心内膜心肌切开术增加了自发性室性心动过速复发/猝死的风险。包括医院死亡病例在内的生存率在术后30天为95%，1年时为89%，5年时为70%。最常见的死亡方式是心力衰竭。无前外侧左心室动脉瘤以及采用更广泛的环行切口技术进行室性心动过速消融增加了早期和晚期死亡的风险。术后复发性持续性室性心动过速复发的患者亚组生存率尤其低；该组最常见的死亡方式也是进行性左心室衰竭。推论：（1）完全和部分环行心内膜心肌切开术切口是消融恶性室性心动过速最有效的手术技术。（2）由于其对左心室结构和功能的不良影响，必须尽可能精确地定位致心律失常组织，且包绕切口应尽可能局限。（3）室性心动过速的晚期复发可能更多与进行性缺血性左心室心肌病有关，而非手术不充分。
