Paolini G, Zuccari M, Mariani M A, Di Credico G, Pocar M, Galli L, Grossi A
Institute for Cardiovascular and Respiratory Diseases, University of Milan, Italy.
Cardiovasc Surg. 1994 Feb;2(1):88-92.
The benefits of myocardial revascularization in patients with ischaemic left ventricular dysfunction are widely reported. However, myocardial revascularization in such cases is associated with higher mortality and morbidity rates. Sixty patients with severe left ventricular dysfunction underwent myocardial revascularization at the authors' institution. Ejection fraction was assessed by angiocardioscintigraphy before and at 3 months after surgery. All patients underwent elective surgery and received complete myocardial revascularization. Myocardial protection was achieved using Buckberg's protocol. One perioperative death occurred. Weaning from cardiopulmonary bypass required inotropic drug therapy in 22 cases and aortic counterpulsation in nine. Perioperative myocardial infarction occurred in three patients with no further haemodynamic impairment. The mean postoperative ejection fraction was 41.0%, compared with a mean preoperative value of 26.5%. The extent of left ventricular functional improvement was greatest in those patients having the worst preoperative left ventricular function. It is concluded that, with this technique, myocardial revascularization can be achieved in patients with severe left ventricular dysfunction with an acceptable operative mortality.
缺血性左心室功能障碍患者进行心肌血运重建的益处已有广泛报道。然而，此类病例的心肌血运重建与更高的死亡率和发病率相关。60例严重左心室功能障碍患者在作者所在机构接受了心肌血运重建。术前及术后3个月通过心血管闪烁造影评估射血分数。所有患者均接受择期手术并实现了完全心肌血运重建。采用巴克伯格方案实现心肌保护。发生了1例围手术期死亡。22例患者在脱离体外循环时需要使用正性肌力药物治疗，9例需要主动脉反搏。3例患者发生围手术期心肌梗死，但未出现进一步的血流动力学损害。术后平均射血分数为41.0%，术前平均射血分数为26.5%。术前左心室功能最差的患者左心室功能改善程度最大。结论是，采用这种技术，严重左心室功能障碍患者可实现心肌血运重建，且手术死亡率可接受。
