Non-transplant surgery for heart failure
Non-transplant surgery for heart failure
复制标题
心力衰竭的非移植手术
作者：
S. Westaby
溶栓和 PTCA 可在急性心肌梗死期间挽救生命，但不完全或延迟再灌注会导致运动不能或运动障碍。如果超过 20% 的左心室周长运动障碍，则剩余的收缩腔扩张以增加每搏输出量。当超过 50% 的心肌受损时，室壁张力增加（拉普拉斯定律）会引发进行性左心室衰竭，并导致心肌细胞胎儿遗传学退化和细胞凋亡。1 2 在英国，大多数心力衰竭是由冠状动脉疾病引起的，尤其是 60 岁以上的患者。尽管接受了最大程度的治疗，现在仍有数十万患者出现虚弱症状。每年有不到 300 例心脏移植手术由 10 个独立单位以劳动密集型方式进行。短期内，更多患有先天性心脏病的年轻患者将需要这些器官。因此，老年冠心病和特发性扩张型心肌病患者的治疗需要彻底重新思考。
以下对当前和新兴心力衰竭手术策略的描述集中于左心室射血分数（LVEF） 25 mm Hg、左心室周向运动不能或运动障碍> 60%、左心室舒张末期容积（LVEDV）> 250 ml（LVEDV指数（LVEDVI）> 140 ml）的患者。这些患者中的大多数为纽约心脏协会 (NYHA) 功能分级 III 或 IV 并接受药物治疗。在冠状动脉疾病中，梗死面积与死亡率之间的关系已得到明确定义（表 1）。3 根据冠状动脉手术研究登记，LVEF < 25% 的患者的五年生存率在接受药物治疗时为 41%，而在接受手术时为 62%。4 对于扩张型心肌病患者，未经治疗的死亡率与收缩功能障碍的严重程度直接相关。心室球形度增加和二尖瓣关闭不全是预后较差的标志（一年死亡率为 54-70%）。在衰竭的心脏中，二尖瓣关闭不全......
Thrombolysis and PTCA save lives during acute myocardial infarction, but incomplete or delayed reperfusion results in akinesia or dyskinesia. If more than 20% of the left ventricular circumference is dyskinetic, the remaining contractile cavity dilates to increase stroke volume. When more than 50% of the myocardium is impaired, increased wall tension (LaPlace's law) triggers progressive left ventricular failure with regression to myocyte fetal genetics and apoptosis.1 2 In Britain, most heart failure is caused by coronary artery disease, particularly in patients over 60 years old. There are now hundreds of thousands of patients with debilitating symptoms despite maximal medical treatment. Less than 300 cardiac transplants per year are undertaken in a labour intensive way by 10 separate units. In a short time, more palliated young patients with congenital heart disease will require these organs. Consequently, the treatment of older patients with coronary disease and idiopathic dilated cardiomyopathy requires a radical rethink.
The following account of current and emerging surgical strategies for heart failure concentrates on those patients with left ventricular ejection fraction (LVEF) 25 mm Hg, left ventricular circumferential akinesia or dyskinesia > 60%, and left ventricular end diastolic volume (LVEDV) > 250 ml (LVEDV index (LVEDVI) > 140 ml). Most of these patients are New York Heart Association (NYHA) functional class III or IV with medical treatment. In coronary disease the relation between infarct size and mortality has been well defined (table 1).3 From the coronary artery surgery study registry, five year survival for patients with LVEF < 25% was 41% with medical treatment and 62% with surgery.4 For patients with dilated cardiomyopathy, mortality untreated is directly related to the severity of systolic dysfunction. Increased chamber sphericity and the presence of mitral regurgitation are markers of worse prognosis (one year mortality 54–70%). In the failing heart, mitral regurgitation …
影响因子：
37.8
作者：
Mancini, DM;Beniaminovitz, A;Oz, M
通讯作者：
Oz, M
影响因子：
2.8
作者：
DICARLI, MF;DAVIDSON, M;MADDAHI, J
通讯作者：
MADDAHI, J
影响因子：
158.5
作者：
Olivetti, G;Abbi, R;Anversa, P
通讯作者：
Anversa, P