Surgical therapy for congestive heart failure: indications for transplantation versus cardiomyoplasty.
Surgical therapy for congestive heart failure: indications for transplantation versus cardiomyoplasty.
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充血性心力衰竭的手术治疗：移植与心肌成形术的适应症。
DOI：
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发表时间：
1992
期刊：
影响因子：
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通讯作者：
J. Orie
中科院分区：
文献类型：
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作者：
J. Magovern;G. Magovern;G. Magovern;M. A. Palumbi;J. Orie
心脏移植是严重充血性心力衰竭患者的首选手术，但由于相关的医疗问题和缺乏供体心脏，许多患者不是候选人。自1988年以来，我们进行了36例心脏移植手术。1年和2年精算生存率分别为82%和73%。16名不适合心脏移植的患者接受了心肌成形术，这是一种将左背阔肌转位至心肌并与心脏同步起搏以增强心脏功能的手术。平均年龄为55岁（范围：39 - 65岁）。术前左、右射血分数分别为24.9% ± 2.1%和43% ± 4.5%。11名患者为纽约心脏协会IV级，5名患者为III级。发生了4例手术死亡，另外3例死亡发生在手术后6个月内。9名患者成为长期存活者，9名患者中有7名在平均随访29个月时存活。所有患者均为纽约心脏协会I级或II级。在长期存活者中，平均左心室射血分数从24.9% ± 2.1%增加到31.8% ± 3.5%（p <0.01）。除1例外，所有手术和早期死亡均发生在双心室衰竭患者中（n = 6）。右室射血分数正常者手术死亡1例，无早期死亡。初步经验表明，心肌成形术可能有助于保留右心室功能的心力衰竭患者，但心脏移植应是双心室衰竭的首选治疗方法。
Heart transplantation is the procedure of choice for patients with severe congestive heart failure, but many patients are not candidates because of associated medical problems and the lack of donor hearts. Since 1988 we have performed 36 heart transplantations. One and 2-year actuarial survival rates have been 82% and 73%. Sixteen patients who were not candidates for heart transplantation have undergone cardiomyoplasty, a procedure in which the left latissimus dorsi is transposed to the myocardium and paced synchronously with the heart to augment cardiac function. The average age was 55 years (range, 39 to 65 years). Preoperative left and right ejection fractions were 24.9% +/- 2.1% and 43% +/- 4.5%. Eleven patients were in the New York Heart Association class IV, and five patients were in class III. Four operative deaths occurred, and three additional deaths occurred within 6 months of surgery. Nine patients became long-term survivors, and seven of nine patients are alive at a mean follow-up of 29 months. All patients are in New York Heart Association class I or II. In long-term survivors, mean left ventricular ejection fraction increased from 24.9% +/- 2.1% to 31.8% +/- 3.5% (p less than 0.01). All but one of the operative and early deaths occurred in patients with biventricular failure (n = 6). One operative death and no early deaths occurred in patients with normal right ventricular ejection fraction. This initial experience suggests that cardiomyoplasty may be helpful for heart failure patients with preserved right ventricular function, but heart transplantation should be the therapy of choice for biventricular failure.