Surgical repair of post infarction ventricular septa defects:: a national experience
Surgical repair of post infarction ventricular septa defects:: a national experience
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DOI：
10.1016/j.ejcts.2004.10.037
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发表时间：
2005-02-01
影响因子：
3.4
通讯作者：
R책degran, K
中科院分区：
文献类型：
--
作者：
Jeppsson, A;Liden, H;R책degran, K
目的：室间隔破裂是急性心肌梗塞后一种罕见但令人担心的并发症。大多数关于手术治疗后结局的报告都是单中心经验。我们调查了瑞典所有患者在7年内手术修复后的结果。方法：1992-1998年接受手术修复的所有患者均在瑞典心脏外科登记处的帮助下确定。患者（n = 189，63%的男性，平均年龄69 - 8岁）在10个不同的中心进行了手术。从登记研究和个体患者图表中收集术前和围手术期变量。计算死亡率，并采用考克斯比例风险回归模型确定早期和晚期死亡率的独立预测因子。平均随访2.4年。结果：189例患者中有77例（41%）在30天内死亡。紧急修复（风险比4.2（2.0-8.9），P < 0.001）和后路破裂（RR 2.1（1.3-3.4），P = 0.002）是30天死亡率的独立预测因素。5年时总累积生存率（Kaplan-Meyer）为38%。对于前30天存活的患者（n = 112），5年累积存活率为67%。30天后死亡率的独立预测因素为合并冠状动脉病变数量（RR 1.5（1.2-2.0），P = 0.001）、术后残余分流（RR 2.7（1.4-5.4），P = 0.004）和术后透析（RR 3.4（1.5-7.5），P = 0.003）。结论：梗死后间隔破裂手术修补后的早期死亡率仍然相当高。早期修复和后路破裂是早期死亡率的预测因素。术后即刻存活的患者的长期生存受到既存冠状动脉疾病、术后肾功能衰竭和术后残余分流的限制。(C)2004 Elsevier B. V.保留所有权利。
Obiectives: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. Methods: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (n = 189, 63% men, mean age 69 8 years) were operated at 10 different centers. Pre- and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late mortality. Mean follow-up was 2.4 years. Results: Seventy-seven of the 189 patients died within 30 days (41%). Urgent repair (Risk Ratio 4.2 (2.0-8.9), P < 0.001) and posterior rupture (RR 2.1 (1.3-3.4), P = 0.002) were independent predictors of 30-day mortality. Total cumulative survival (Kaplan-Meyer) was 38% at 5 years. For patients that survived the first 30 days (n = 112), 5 year cumulative survival was 67%. Independent predictors for mortality after 30 days were number of concomitant coronary anastomoses (RR 1.5 (1.2-2.0), P = 0.001), residual postoperative shunt (RR 2.7 (1.4-5.4), P = 0.004) and postoperative dialysis (RR 3.4 (1.5-7.5), P = 0.003). Conclusions: Early mortality after surgical repair of post infarction septal rupture is still considerable. Early repair and posterior rupture are predictors of early mortality. Long-term survival in patients surviving the immediate postoperative period is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt. (C) 2004 Elsevier B.V. All rights reserved.