Babliak Oleksandr, Babliak Dmytro, Lazoryshynets Vasyl, Revenko Katerina, Melnyk Yevhenii, Stohov Oleksii
Cardiac Surgery Department, Diagnostic and Treatment Center For Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine.
National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
Innovations (Phila). 2025 May-Jun;20(3):272-275. doi: 10.1177/15569845251333424. Epub 2025 May 14.
To describe the technique and the results of left ventricular aneurysm (LVA) repair with simultaneous coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery through the left anterior thoracotomy.
Between October 2018 and June 2024, a cohort of 40 patients underwent repair for postinfarction LVA through left anterior thoracotomy. Simultaneous procedures included CABG (40 patients, 100%) and MV surgery (15 patients, 37.5%) and were performed through the same thoracotomy incision. The mean age of the patients was 61.4 ± 11.4 years (range, 33 to 82 years), the mean body mass index was 27.9 ± 4.3 kg/m (range, 19.9 to 35.9 kg/m), and the mean LV ejection fraction was 29.9% ± 8.6% (range, 10% to 55%). The surgical technique in all patients included peripheral cardiopulmonary bypass, minithoracotomy in the fourth intercostal space, aortic cross-clamping, and cold blood cardioplegia.
Successful visualization and repair of the LVA and complete revascularization was achieved in all patients without conversion to sternotomy. The mean number of distal anastomoses per patient was 2.03 ± 1.12 (range, 1 to 5). The mean cardiopulmonary bypass time was 207 ± 51.0 min, and the mean cross-clamp time was 115.5 ± 28.7 min. The average intensive care unit stay was 2.1 ± 1.4 days (range, 1 to 8 days), and the total hospital stay was 6.8 ± 2.9 days (range, 4 to 14 days). No strokes, major complications, or hospital mortality were observed. The 30-day mortality included 1 patient.
LVA repair (isolated or combined with simultaneous cardiac surgical procedures) through the left anterior thoracotomy is shown to be efficient and safe in our experience.
描述经左前外侧开胸同期行冠状动脉旁路移植术（CABG）和/或二尖瓣（MV）手术修复左心室室壁瘤（LVA）的技术及结果。
2018年10月至2024年6月，一组40例患者经左前外侧开胸修复心肌梗死后LVA。同期手术包括CABG（40例患者，100%）和MV手术（15例患者，37.5%），均通过同一开胸切口进行。患者的平均年龄为61.4±11.4岁（范围33至82岁），平均体重指数为27.9±4.3kg/m²（范围19.9至35.9kg/m²），平均左心室射血分数为29.9%±8.6%（范围10%至55%）。所有患者的手术技术包括外周体外循环、第四肋间小切口开胸、主动脉阻断和冷血心脏停搏。
所有患者均成功实现LVA的可视化和修复以及完全血运重建，无需转为胸骨正中切开术。每位患者远端吻合口的平均数量为2.03±1.12（范围1至5）。平均体外循环时间为207±51.0分钟，平均阻断时间为115.5±28.7分钟。平均重症监护病房住院时间为2.1±1.4天（范围1至8天），总住院时间为6.8±2.9天（范围4至14天）。未观察到中风、重大并发症或医院死亡。30天死亡率包括1例患者。
根据我们的经验，经左前外侧开胸修复LVA（单独或与同期心脏手术联合）是有效且安全的。
