Dalrymple-Hay M J, Monro J L, Livesey S A, Lamb R K
Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Semin Thorac Cardiovasc Surg. 1998 Apr;10(2):111-6. doi: 10.1016/s1043-0679(98)70004-8.
Surgical repair of a postinfarct ventricular septal defect (VSD) remains a difficult surgical challenge associated with a significant operative mortality. Between 1972 and 1995, 179 patients with a postinfarct VSD have undergone operation in this institution. There were 118 males and 61 females, with a mean age of 66 years (range 43 to 80). Operative mortality was 26.7%. Surgery was deferred until 1 month after the septal rupture in 29 patients, with these labeled as having a chronic VSD. The remaining 150 underwent operation on within 1 month of infarction and are described as having an acute VSD. For those with an acute VSD, factors significantly associated with an increased risk of 30-day mortality included preoperative New York Heart Association status (P = .04), site of myocardial infarction (inferior worse than anterior) (P = .004), cross-clamp time (P = .05) and cardiopulmonary bypass time (P = .0001) (logistic regression). On multiple logistic regression, only cardiopulmonary bypass time remained significant. Survival including in-hospital mortality at 5 and 10 years was 49% +/- 4% and 31% +/- 5% and excluding in-hospital mortality was 72% +/- 5% and 45% +/- 6%, respectively. Those patients who survived attained a good quality of life. No factors were significantly associated with prolonged survival.
心肌梗死后室间隔缺损（VSD）的手术修复仍然是一项具有挑战性的外科难题，手术死亡率颇高。1972年至1995年间，本机构对179例心肌梗死后室间隔缺损患者进行了手术。其中男性118例，女性61例，平均年龄66岁（范围43至80岁）。手术死亡率为26.7%。29例患者手术推迟至室间隔破裂1个月后进行，这些患者被标记为患有慢性室间隔缺损。其余150例在梗死1个月内接受手术，被描述为患有急性室间隔缺损。对于急性室间隔缺损患者，与30天死亡率增加显著相关的因素包括术前纽约心脏协会心功能分级（P = 0.04）、心肌梗死部位（下壁比前壁更差）（P = 0.004）、主动脉阻断时间（P = 0.05）和体外循环时间（P = 0.0001）（逻辑回归分析）。在多因素逻辑回归分析中，只有体外循环时间仍然具有显著性。包括住院死亡率在内的5年和10年生存率分别为49%±4%和31%±5%，不包括住院死亡率时分别为72%±5%和45%±6%。存活的患者生活质量良好。没有因素与长期生存显著相关。
