Luciani G B, Faggian G, Razzolini R, Livi U, Bortolotti U, Mazzucco A
Department of Cardiovascular Surgery and Cardiology, University of Padova, Italy.
Ann Thorac Surg. 1993 Mar;55(3):719-23. doi: 10.1016/0003-4975(93)90282-m.
Severe left ventricular failure in ischemic heart disease may contraindicate conservative surgical procedures. To redefine therapeutic indications, the clinical and angiographic data of 143 patients (137 men and 6 women) with ischemic heart disease and a left ventricular ejection fraction less than 0.30 who were seen by us between June 1985 and December 1990 were retrospectively analyzed. Patients were divided into three groups according to therapy: medical only, 72 (group 1); myocardial revascularization, 20 (group 2); and heart transplantation, 51 (group 3). Clinical status was poorer in group 3, with congestive heart failure as predominant symptom; angina was more frequent in group 2. No difference was noted in hemodynamic variables. Four early deaths (20.0%) occurred in group 2 and 7 (13.7%) in group 3. Follow-up ranged from 1 to 64 months (mean, 22 +/- 19 months), with an actuarial survival of 28% +/- 9%, 80% +/- 8% and 82% +/- 5% at 5 years in groups 1, 2, and 3, respectively. Even though postoperative New York Heart Association class was better in group 3 (1.0 versus 2.3 in group 2; p < 0.01), the difference in survival was not significant. Although in patients with ischemic heart disease and low left ventricular ejection fraction heart transplantation offers the best clinical results, considering the donor shortage, we conclude that myocardial revascularization may still be performed with good midterm results.
缺血性心脏病所致的严重左心室衰竭可能是保守性外科手术的禁忌证。为重新界定治疗指征，我们对1985年6月至1990年12月期间诊治的143例（137例男性和6例女性）缺血性心脏病且左心室射血分数小于0.30的患者的临床和血管造影资料进行了回顾性分析。根据治疗方法将患者分为三组：单纯药物治疗组，72例（第1组）；心肌血运重建组，20例（第2组）；心脏移植组，51例（第3组）。第3组的临床状况较差，以充血性心力衰竭为主要症状；第2组心绞痛更为常见。血流动力学变量未见差异。第2组发生4例早期死亡（20.0%），第3组发生7例（13.7%）。随访时间为1至64个月（平均22±19个月），第1、2和3组5年的精算生存率分别为28%±9%、80%±8%和82%±5%。尽管第3组术后纽约心脏协会心功能分级较好（第2组为2.3级，第3组为1.0级；p<0.01），但生存率差异无统计学意义。虽然对于缺血性心脏病且左心室射血分数低的患者，心脏移植可提供最佳临床结果，但考虑到供体短缺，我们得出结论，心肌血运重建仍可进行，且中期结果良好。
