Dreyfus G D, Duboc D, Blasco A, Vigoni F, Dubois C, Brodaty D, de Lentdecker P, Bachet J, Goudot B, Guilmet D
Department of Cardio-Vascular Surgery and Transplantation, Hôpital Foch, Paris V University, Suresnes, France.
Ann Thorac Surg. 1994 Jun;57(6):1402-7; discussion 1407-8. doi: 10.1016/0003-4975(94)90091-4.
Patients with ischemic heart disease, congestive heart failure, and low ejection fraction are usually referred for orthotopic heart transplantation. Based on results of myocardial viability assessment, we have prospectively used either coronary artery bypass grafting or orthotopic heart transplantation. From January 1990 to June 1992, among 50 patients initially referred for heart transplantation, 46 showing myocardial viability underwent bypass grafting. Forty-five of these 46 patients were men, and the mean age was 58 +/- 12 years (range, 40 to 70 years). Congestive heart failure was present in all patients, and dyspnea was the main symptom in 80% (37/46). Patients were selected according to three criteria. (1) Myocardial viability was primarily assessed by thallium scintigraphy for up to 24 hours (28/46 patients). When results were negative, patients underwent positron emission tomography (20/46 patients). (2) Regional left ventricular function was assessed using gated blood pool single-photon emission computed tomography combined with (3) full hemodynamic evaluation. Results were as follows: end-diastolic volume, 129 +/- 35 mL/m2; ejection fraction, 0.23 +/- 0.06; cardiac index, 2.4 +/- 0.62 L.min-1.m-2; mean pulmonary artery pressure, 26 +/- 0.90 mm Hg; and mean pulmonary capillary wedge pressure, 16 +/- 1.10 mm Hg. Operative mortality was 2.17% (1/46). During follow-up (mean duration, 18 months), there were three late cardiac-related deaths (arrhythmias) and two noncardiac-related deaths. The 40 long-term survivors are in New York Heart Association class II. Angiography (15 patients) or gated blood pool single photon emission tomography (32) showed improvement in mean ejection fraction to 0.39 +/- 0.13 (range, 0.22 to 0.46).(ABSTRACT TRUNCATED AT 250 WORDS)
患有缺血性心脏病、充血性心力衰竭且射血分数较低的患者通常会被转诊进行原位心脏移植。根据心肌活力评估结果，我们前瞻性地采用了冠状动脉旁路移植术或原位心脏移植术。1990年1月至1992年6月，在最初转诊进行心脏移植的50例患者中，46例显示有心肌活力，接受了旁路移植术。这46例患者中有45例为男性，平均年龄为58±12岁（范围为40至70岁）。所有患者均存在充血性心力衰竭，80%（37/46）的患者以呼吸困难为主要症状。根据三项标准选择患者。（1）心肌活力主要通过长达24小时的铊闪烁扫描进行评估（28/46例患者）。当结果为阴性时，患者接受正电子发射断层扫描（20/46例患者）。（2）使用门控血池单光子发射计算机断层扫描结合（3）全面血流动力学评估来评估局部左心室功能。结果如下：舒张末期容积，129±35 mL/m²；射血分数，0.23±0.06；心脏指数，2.4±0.62 L·min⁻¹·m⁻²；平均肺动脉压，26±0.90 mmHg；平均肺毛细血管楔压，16±1.10 mmHg。手术死亡率为2.17%（1/46）。在随访期间（平均持续时间为18个月），有3例晚期心脏相关死亡（心律失常）和2例非心脏相关死亡。40例长期存活者的心功能分级为纽约心脏协会II级。血管造影（15例患者）或门控血池单光子发射断层扫描（32例）显示平均射血分数提高至0.39±0.13（范围为0.22至0.46）。（摘要截选至250字）
