Grossi E A, Chinitz L A, Galloway A C, Delianides J, Schwartz D S, McLoughlin D E, Keller N, Kronzon I, Spencer F C, Colvin S B
Department of Surgery, New York University Medical Center, NY 10016, USA.
Circulation. 1995 Nov 1;92(9 Suppl):II98-100. doi: 10.1161/01.cir.92.9.98.
Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function.
From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years.
These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function.
左心室室壁瘤（LVA）修复手术技术的最新进展包括使用心室内补片来隔离瘤腔。该技术已取代传统的瘤体线性折叠术。心室内补片技术可将左心室腔重塑为更符合生理的几何形状，从而改善心脏功能。
1989年12月至1993年11月期间，45例患者接受了心室内补片修复LVA手术。40例患者在手术同时进行了冠状动脉旁路移植术。28例患者（62.2%）还进行了非指导性心内膜下环形切口。手术操作包括7例急诊手术、3例同期瓣膜手术，每位患者平均进行2.2次旁路移植。8例患者曾接受过心脏手术。所有患者的医院死亡率为15.6%（7/45），非急诊血运重建和LVA修复患者的死亡率为9.1%（3/33）。射血分数从术前平均25.8%提高到术后37.8%；纽约心脏协会平均分级从3.5提高到1.5。已知术前有心律失常（可诱发或猝死）的患者中，69%术后在未使用抗心律失常药物的情况下不再可诱发心律失常。2年时晚期心源性死亡（包括不明原因死亡）的生存率为86.5%。2年时记录到的室性心律失常的无发生率为94.3%。
这些结果表明，补片内室壁瘤修补术可在LVA及心室功能严重受损的患者中提供良好的功能和生理结果。
