Influence of Left Ventricular Aneurysm on Survival Following the Coronary Bypass Operation
Influence of Left Ventricular Aneurysm on Survival Following the Coronary Bypass Operation
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左心室动脉瘤对冠状动脉搭桥术后生存的影响
DOI：
10.1097/00000658-198106000-00008
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发表时间：
1981
影响因子：
9
通讯作者：
C. Hatcher
中科院分区：
文献类型：
--
作者：
E. Jones;J. Craver;J. Hurst;J. Bradford;D. K. Bone;P. H. Robinson;B. W. Cobbs;T. Thompkins;C. Hatcher
将行冠状动脉搭桥术和动脉瘤切除术（N = 40）或动脉瘤折叠术（N = 32）的患者与行冠状动脉搭桥术但无动脉瘤的患者（N = 2782）进行比较。与其他系列不同，动脉瘤患者手术的主要适应症是心绞痛，心力衰竭起次要作用。83%的动脉瘤患者存在多支血管疾病。冠状动脉前降支完全闭塞在行冠状动脉切除术的患者组（75%）中比行折叠术的患者组（38%）更普遍，折叠术组可进行更多的移植物/患者（2.6 vs 2.0）。动脉瘤的位置最常见于前心尖（N = 55），很少位于下方（N = 6）。47%的室间隔切除术组和10%的折叠术组的室间隔壁运动无动力或不规则。动脉瘤组（动脉瘤切除术或折叠术）对正性肌力药物或主动脉内球囊辅助的术后需求远高于无动脉瘤搭桥的患者。动脉瘤患者的住院死亡率为2.7%，而无动脉瘤的冠状动脉搭桥患者的住院死亡率为1.4%。所有动脉瘤患者的42个月精算生存率为90%。折叠术和冠状动脉搭桥术后心绞痛症状的改善（96%）比肠系膜切除术和冠状动脉搭桥术（76%）更常见，这归因于更大的活肌质量和更大的血运重建。尽管三分之二的动脉瘤手术患者术后心力衰竭症状有所改善，但30%的动脉瘤切除术患者和35%的动脉瘤折叠术患者表示手术后没有改善。然而，这可以通过以下发现来解释：手术前有大量患者（35%的虹膜切除术组和45%的折叠术组）处于I级心力衰竭。左心室室壁瘤的手术治疗，主要是通过早期手术，使住院死亡率逐渐降低，晚期生存率增加，此时冠状动脉搭桥术可用作动脉瘤切除术或折叠术的辅助手段。
Patients having coronary bypass and aneurysm resection (N = 40) or aneurysm plication (N = 32) were compared with patients having coronary bypass without aneurysm (N = 2782). Unlike other series, the primary indication for surgery in the aneurysm patients was angina pectoris, with heart failure playing a secondary role. Multivessel disease was present in 83% of the patients with aneurysm. Total occlusion of the anterior descending coronary artery was more prevalent in the group of patients who had aneurysmectomy (75%) than in the group of patients who had plication (38%), and more grafts/ patient could be performed in the plication group (2.6 vs 2.0). Location of the aneurysm was most often antcroapical (N = 55) and infrequently inferior (N = 6). Septal wall motion was akinetic or aneurysmal in 47% of the aneurysmectomy group, and 10% of the plication group. Postoperative requirements for inotropcs or intra-aortic balloon assist was much higher in the aneurysm group (aneurysmectomy or plication) than in patients without aneurysm having bypass. Hospital mortality for aneurysm patients was 2.7% versus 1.4% in patients without aneurysms having coronary bypass. The actuarial survival rate at 42 months for all aneurysm patients was 90%. Improvement in anginal symptoms after plication and coronary bypass (96%) was more frequent than with aneurysmectomy and coronary bypass (76%) and this was attributed to larger viable muscle mass and greater revascularization. Although two-thirds of patients having surgery for aneurysms had improvement in heart failure symptoms after operation, 30% of those having aneurysmcctomies and 35% of those having plications said they were unimproved after surgery. However, this could be explained by the finding that a significant number (35% of the aneurysmectomy and 45% of the plication group) were in heart failure Class I prior to operation. Hospital mortality has been progressively reduced and late survival increased by the surgical treatment of left ventricular aneurysm, primarily through early operation at a time when coronary bypass can be used as an adjunct to aneurysm resection or plication.