Di Biasi P, Scrofani R, Moriggia S, Di Biasi M, Botta M, Mariani M, Santoli C
Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale L. Sacco, Milano.
G Ital Cardiol. 1996 Oct;26(10):1139-47.
The study was designed to evaluate short and long-term benefits of coronary artery bypass graft in patients with coronary artery disease and severely depressed left ventricular ejection fraction and to identify contemporary risk factors associated with significantly greater mortality in this high-risk subgroup.
From 1985 to 1995, 200 consecutive pts with EF < or = 0.30 underwent CABG. Among these patients, 60% were older than 70 years. NYHA functional class III/IV was present in 31% of pts. Preoperative mean cardiac index was 2.7 +/- 7 l/min/m2, mean pulmonary artery pressure was 29.9 +/- 7 mm Hg and contractility score (generated by appropriate software for left ventricular kinesis analysis) mean value was 50.1 +/- 11.6 points. Urgent operation was required in 32 pts (16%). The majority of pts were completely revascularized.
Operative mortality was 9% (18 pts). Low output syndrome was the most common postoperative complication (13.5%) followed by ventricular arrhythmia (8%), mean length of postoperative hospitalization for survivors was 13 +/- 10 days. Of 23 possible operative risk factors evaluated, four were associated with significantly greater mortality: cardiac index < or = 2.1 l/min/m2, urgent operation, contractility score > or = 80 and associated surgical procedures. Survivors experienced significant improvement in CHF class (p < 0.001) and follow up EF (p < 0.001). Kaplan-Meier estimate of survival at 1 year, 5 years and 8 years was 85%, 65% and 54%.
Through more careful assessment of preoperative risk factors, patients selection and perioperative management, actually coronary artery bypass graft may be offered to pts with low ejection fraction with reduced morbidity and mortality.
本研究旨在评估冠状动脉旁路移植术对冠心病合并严重左心室射血分数降低患者的短期和长期益处，并确定这一高危亚组中与显著更高死亡率相关的当代危险因素。
1985年至1995年，连续200例左心室射血分数（EF）≤0.30的患者接受了冠状动脉旁路移植术（CABG）。在这些患者中，60%年龄超过70岁。31%的患者纽约心脏协会（NYHA）心功能分级为III/IV级。术前平均心脏指数为2.7±0.7 l/min/m²，平均肺动脉压为29.9±7 mmHg，收缩力评分（通过用于左心室运动分析的适当软件生成）平均值为50.1±11.6分。32例患者（16%）需要急诊手术。大多数患者实现了完全血运重建。
手术死亡率为9%（18例患者）。低心排血量综合征是最常见的术后并发症（13.5%），其次是室性心律失常（8%），幸存者术后平均住院时间为13±10天。在评估的23个可能的手术危险因素中，有4个与显著更高的死亡率相关：心脏指数≤2.1 l/min/m²、急诊手术、收缩力评分≥80以及相关手术操作。幸存者的心衰分级（p<0.001）和随访时的射血分数（p<0.001）有显著改善。1年、5年和8年的Kaplan-Meier生存估计分别为85%、65%和54%。
通过更仔细地评估术前危险因素、患者选择和围手术期管理，实际上可以为射血分数低的心衰患者提供冠状动脉旁路移植术，从而降低发病率和死亡率。
