Dor V, Sabatier M, Di Donato M, Maioli M, Toso A, Montiglio F
Centre Cardio-Thoracique de Monaco, Monaco.
J Thorac Cardiovasc Surg. 1995 Nov;110(5):1291-9; discussion 1300-1. doi: 10.1016/S0022-5223(95)70052-8.
This study reports hemodynamic, electrophysiologic, and clinical results in 171 patients (157 men and 14 women, mean age 57 +/- 8 years) 1 year after endoventricular circular patch repair and coronary grafting for postinfarction left ventricular dyskinetic or akinetic aneurysm. All patients had hemodynamic and electrophysiologic study before the operation and early and 1 year after the operation. The vast majority of aneurysms were anterior (n = 166), with a mean delay from infarction of 43 +/- 50 months. Fifty-two percent of patients were in New York Heart Association class III or IV, and preoperative ejection fraction was less than 40% in the majority of them (75%). Preoperative clinical ventricular tachycardia was present in 25 patients and was inducible in 59 patients. All patients had endoventricular circular patch repair with a synthetic (n = 99) or autologous patch (n = 72); 96% had associated coronary grafting with a mean number of bypass grafts of 1.9 +/- 0.9. Results at 1 year demonstrated a significant increase in ejection fraction (from 36% +/- 13% to 46% +/- 12% (p < 0.0001) and a significant reduction in ventricular volumes (end-diastolic volume index from 116 +/- 5 to 94 +/- 29 ml/m2 and end-systolic volume index from 77 +/- 45 to 53 +/- 25 ml/m2, p < 0.0001). New York Heart Association functional classification was significantly improved (2.6 +/- 0.9 vs 1.4 +/- 0.6, p < 0.0001) and ventricular tachycardias were almost suppressed (no documented clinical ventricular tachycardias and 8% incidence of inducible ventricular tachycardias after 1 year, chi 2 < 0.001). Patients who benefit most from the operation are those with more severe preoperative left ventricular dysfunction (i.e., ejection fraction < 30%), more frequent ventricular arrhythmias, and larger ventricular volumes. At regression analysis, critical disease of the right coronary artery was the only independent predictor of unsatisfactory pump improvement (as evaluated by postoperative increase of ejection fraction < 10 absolute points). In conclusion, in our large series of patients operated on by one surgical team between 1988 and 1993, who were studied hemodynamically both before and after the operation, endoventricular circular patch repair of left ventricular aneurysm associated with coronary grafting definitely improves left ventricular pump function and clinical status 1 year after the operation.
本研究报告了171例患者（157例男性和14例女性，平均年龄57±8岁）在接受梗死后期左心室运动障碍或运动不能性动脉瘤的心室内环形补片修复及冠状动脉移植术后1年的血流动力学、电生理和临床结果。所有患者在手术前、术后早期及术后1年均进行了血流动力学和电生理研究。绝大多数动脉瘤位于前壁（n = 166），距梗死的平均延迟时间为43±50个月。52%的患者属于纽约心脏协会III级或IV级，其中大多数（75%）术前射血分数低于40%。25例患者术前存在临床室性心动过速，59例患者可诱发出室性心动过速。所有患者均接受了合成补片（n = 99）或自体补片（n = 72）的心室内环形补片修复；96%患者同时进行了冠状动脉移植，平均搭桥数量为1.9±0.9。1年时的结果显示射血分数显著增加（从36%±13%增至46%±12%，p < 0.0001），心室容积显著减小（舒张末期容积指数从116±5降至94±29 ml/m²，收缩末期容积指数从77±45降至53±25 ml/m²，p < 0.0001）。纽约心脏协会功能分级显著改善（2.6±0.9对1.4±0.6，p < 0.0001），室性心动过速几乎得到抑制（1年后无记录的临床室性心动过速，可诱发性室性心动过速发生率为8%，χ²< 0.001）。从手术中获益最大的患者是术前左心室功能障碍更严重（即射血分数< 30%）、室性心律失常更频繁且心室容积更大的患者。回归分析显示，右冠状动脉严重病变是泵功能改善不令人满意的唯一独立预测因素（通过术后射血分数绝对值增加< 10个百分点来评估）。总之，在我们1988年至1993年间由一个手术团队进行手术且术前术后均进行血流动力学研究的大量患者系列中，左心室动脉瘤的心室内环形补片修复联合冠状动脉移植在术后1年确实改善了左心室泵功能和临床状况。
