LATE HEMODYNAMIC-RESULTS AFTER LEFT-VENTRICULAR PATCH REPAIR ASSOCIATED WITH CORONARY GRAFTING IN PATIENTS WITH POSTINFARCTION AKINETIC OR DYSKINETIC ANEURYSM OF THE LEFT-VENTRICLE
LATE HEMODYNAMIC-RESULTS AFTER LEFT-VENTRICULAR PATCH REPAIR ASSOCIATED WITH CORONARY GRAFTING IN PATIENTS WITH POSTINFARCTION AKINETIC OR DYSKINETIC ANEURYSM OF THE LEFT-VENTRICLE
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DOI：
10.1016/s0022-5223(95)70052-8
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发表时间：
1995-11-01
影响因子：
6
通讯作者：
MONTIGLIO, F
中科院分区：
文献类型：
--
作者：
DOR, V;SABATIER, M;MONTIGLIO, F
本研究报告了 171 名患者（157 名男性和 14 名女性，平均年龄 57 +/- 8 岁）因梗塞后左心室运动障碍或运动不能性动脉瘤进行心室内圆形补片修复和冠状动脉移植术后 1 年的血流动力学、电生理学和临床结果。所有患者术前、术后早期及术后1年均进行血流动力学和电生理检查。绝大多数动脉瘤位于前部 (n = 166)，梗塞发生的平均延迟时间为 43 +/- 50 个月。 52% 的患者属于纽约心脏协会 III 级或 IV 级，其中大多数 (75%) 术前射血分数低于 40%。 25 名患者术前出现临床室性心动过速，59 名患者可诱发。所有患者均使用合成补片（n = 99）或自体补片（n = 72）进行心室内圆形补片修复； 96% 的患者进行了冠状动脉移植术，旁路移植术的平均数量为 1.9 +/- 0.9。 1 年时的结果表明，射血分数显着增加（从 36% +/- 13% 到 46% +/- 12% (p < 0.0001)，心室容积显着减少（舒张末期容积指数从 116 +/- 5 到 94 +/- 29 ml/m(2)，收缩末期容积指数从 77 +/- 45 到 53 +/- 25） ml/m(2)，p < 0.0001）纽约心脏协会功能分类显着改善（2.6 +/- 0.9 vs 1.4 +/- 0.6，p < 0.0001），室性心动过速几乎受到抑制（无记录的临床室性心动过速，1 年后诱发性室性心动过速的发生率为 8%，chi(2) < 0.001）。手术中大多数患者术前左心室功能不全（即射血分数 < 30%）、室性心律失常更频繁以及心室容积较大。在回归分析中，右冠状动脉危重疾病是泵血改善不满意的唯一独立预测因素（通过术后射血分数增加 < 10 个绝对点来评估）。 1993年，对手术前后的血流动力学研究表明，左心室圆形补片修复联合冠状动脉移植术确实改善了左心室泵功能和术后1年的临床状态。
This study reports hemodynamic, electrophysiologic, and clinical results in 171 patients (157 men and 14 women, mean age 57 +/- 8 years) 1 year after endoventricular circular patch repair and coronary grafting for postinfarction left ventricular dyskinetic or akinetic aneurysm. All patients had hemodynamic and electrophysiologic study before the operation and early and 1 year after the operation. The vast majority of aneurysms were anterior (n = 166), with a mean delay from infarction of 43 +/- 50 months. Fifty-two percent of patients were in New York Heart Association class III or IV, and preoperative ejection fraction was less than 40% in the majority of them (75%). Preoperative clinical ventricular tachycardia was present in 25 patients and was inducible in 59 patients. All patients had endoventricular circular patch repair with a synthetic (n = 99) or autologous patch (n = 72); 96% had associated coronary grafting with a mean number of bypass grafts of 1.9 +/- 0.9. Results at 1 year demonstrated a significant increase in ejection fraction (from 36% +/- 13% to 46% +/- 12% (p < 0.0001) and a significant reduction in ventricular volumes (end-diastolic volume index from 116 +/- 5 to 94 +/- 29 ml/m(2) and end-systolic volume index from 77 +/- 45 to 53 +/- 25 ml/m(2), p < 0.0001). New York Heart Association functional classification was significantly improved (2.6 +/- 0.9 vs 1.4 +/- 0.6, p < 0.0001) and ventricular tachycardias were almost suppressed (no documented clinical ventricular tachycardias and 8% incidence of inducible ventricular tachycardias after 1 year, chi(2) < 0.001). Patients who benefit most from the operation are those,vith more severe preoperative left ventricular dysfunction (i.e., ejection fraction < 30%), more frequent ventricular arrhythmias, and larger ventricular volumes. At regression analysis, critical disease of the right coronary artery was the only independent predictor of unsatisfactory pump improvement (as evaluated by postoperative increase of ejection fraction < 10 absolute points). In conclusion, in our large series of patients operated on by one surgical team between 1988 and 1993, who were studied hemodynamically both before and after the operation, endoventricular circular patch repair of left ventricular aneurysm associated with coronary grafting definitely improves left ventricular pump function and clinical status 1 year after the operation.