Magovern J A, Hunter T J, Cardone J C, Christlieb I Y
Cardiovascular & Pulmonary Research Center, Allegheny-Singer Research Institute, Pittsburgh, Pennsylvania, USA.
J Card Surg. 1996 Jul-Aug;11(4):264-70. doi: 10.1111/j.1540-8191.1996.tb00049.x.
Initial experimental and clinical studies have shown that cardiomyoplasty using the right latissimus dorsi can improve left ventricular (LV) function early after operation.
This study presents the long-term clinical results of this procedure. Between March 1991 and November 1992, 16 patients (12 men, 4 women; mean age 57; range 33-77 years) underwent operation. Survivors were evaluated at 6-month intervals for 2 years with right heart catheterization, radionuclide scans, exercise testing, and quality of life questionnaires.
The operative mortality was 6% (1/16), but 3 additional patients experienced sudden death within 6 months of operation. Survival was 63% (10/16) at 12 months and 50% (8/16) at 24 months. There were no significant changes in hemodynamic variables at 12 or 24 months after surgery. Left ventricular ejection fraction increased from 26.1 +/- 5.3 to 33.4 +/- 10.3 (p < 0.05) 6 weeks after operation, but was not different from baseline thereafter. The LV end-diastolic volume decreased significantly at 6 months from 306.1 +/- 71 to 249.4 +/- 69 mL (p < 0.01), and remained lower than the preoperative value in subsequent follow-up. Comparison of preoperative LV ejection fraction and LV stroke work index in 24-month survivors (7) and nonsurvivors (9) showed that survivors had better LV function before surgery. Functional status and quality of life were improved.
Long-term results of right latissimus dorsi cardiomyoplasty are comparable to results using the left latissimus dorsi. Overall survival was limited by late sudden death, but survivors had improved functional capacity and stable LV function and size.
最初的实验和临床研究表明，采用右背阔肌进行心肌成形术可在术后早期改善左心室（LV）功能。
本研究展示了该手术的长期临床结果。在1991年3月至1992年11月期间，16例患者（12例男性，4例女性；平均年龄57岁；范围33 - 77岁）接受了手术。对幸存者每隔6个月进行为期2年的评估，评估内容包括右心导管检查、放射性核素扫描、运动测试以及生活质量问卷调查。
手术死亡率为6%（1/16），但另有3例患者在术后6个月内猝死。12个月时生存率为63%（10/16），24个月时为50%（8/16）。术后12个月或24个月时血流动力学变量无显著变化。术后6周左心室射血分数从26.1±5.3增加至33.4±10.3（p < 0.05），但此后与基线无差异。左心室舒张末期容积在6个月时从306.1±71显著降至249.4±69 mL（p < 0.01），且在随后的随访中一直低于术前值。对24个月幸存者（7例）和非幸存者（9例）术前左心室射血分数和左心室每搏功指数的比较显示，幸存者术前左心室功能更好。功能状态和生活质量得到改善。
右背阔肌心肌成形术的长期结果与左背阔肌手术的结果相当。总体生存率受晚期猝死限制，但幸存者的功能能力有所改善，左心室功能和大小保持稳定。
