Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
ESC Heart Fail. 2024 Jun;11(3):1657-1665. doi: 10.1002/ehf2.14733. Epub 2024 Feb 28.
Due to its low incidence, poor prognosis, and high mortality in the acute phase, the long-term prognosis of the left ventricular aneurysm (LVA) complicated by ventricular septal rupture (VSR) has received little attention. This study focus on the long-term prognosis of patients with LVA complicated by relatively stable VSR.
Over a decade of retrospection, 68 patients with both LVA and VSR were compared with 136 patients with LVA alone after propensity score matching. Patients with both LVA and VSR were further divided into two groups depending on whether pre-operative intra-aortic balloon pump (IABP) was used (23 pre-operative IABP vs. 45 non-pre-operative IABP). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events, a composite endpoint including mortality, myocardial infarction, revascularization, stroke, and heart failure. Patients with both LVA and VSR were generally in a worse condition upon admission compared with those with LVA alone [percentage of patients in New York Heart Association IV: 42.6% (29/68) vs. 11.0% (15/136), P < 0.001]. Both pre-operative and post-operative IABP use rates were significantly higher in patients with both LVA and VSR than in patients with LVA alone [pre-operative IABP use rates: 33.8% (23/68) vs. 0.74% (1/136), P < 0.001 and post-operative IABP use rates: 33.8% (23/68) vs. 10.3% (14/136), P < 0.001]. No significant difference was observed in the primary endpoint between patients with both LVA and VSR and those with LVA alone (log-rank test, P = 0.63, median follow-up time 63 months). We further investigated the effect of pre-operative IABP on the long-term prognosis of patients with both LVA and VSR. Patients who applied pre-operative IABP had a worse long-term prognosis than those who did not (log-rank test, P = 0.0011).
The long-term prognosis of LVA combined with VSR was not inferior than LVA alone after surgery, but poor blood perfusion status was associated with a worse prognosis.
由于左心室室壁瘤（LVA）并发室间隔破裂（VSR）的发病率低、预后差、急性期死亡率高，其长期预后一直未受到重视。本研究旨在关注并发相对稳定 VSR 的 LVA 患者的长期预后。
通过回顾性分析超过十年的数据，对 LVA 合并 VSR 的 68 例患者与单纯 LVA 的 136 例患者进行倾向性评分匹配。根据术前是否使用主动脉内球囊反搏（IABP），将 LVA 合并 VSR 患者进一步分为两组（术前 IABP 组 23 例，非术前 IABP 组 45 例）。主要终点定义为主要不良心血管和脑血管事件，复合终点包括死亡率、心肌梗死、血运重建、卒中和心力衰竭。与单纯 LVA 患者相比，LVA 合并 VSR 患者入院时的一般情况较差[纽约心脏协会（NYHA）心功能分级 IV 级患者比例：42.6%（29/68）比 11.0%（15/136），P<0.001]。LVA 合并 VSR 患者术前和术后使用 IABP 的比例均明显高于单纯 LVA 患者[术前使用 IABP 比例：33.8%（23/68）比 0.74%（1/136），P<0.001；术后使用 IABP 比例：33.8%（23/68）比 10.3%（14/136），P<0.001]。LVA 合并 VSR 患者与单纯 LVA 患者的主要终点无显著差异（对数秩检验，P=0.63，中位随访时间 63 个月）。我们进一步研究了术前 IABP 对 LVA 合并 VSR 患者长期预后的影响。应用术前 IABP 的患者预后较差（对数秩检验，P=0.0011）。
LVA 合并 VSR 患者术后长期预后并不劣于单纯 LVA，但血流灌注状态较差与预后较差相关。
