外科心室重建在缺血性心肌病治疗中的角色

Department of Cardiovascular Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Rd, Shanghai, 200025, China

Background: Surgical ventricular restoration (SVR) has been applied as a valuable adjunct procedure for patients undergoing coronary artery bypass grafting (CABG) to correct the geometry of the left ventricle on the basis of myocardial revascularization. It is necessary to find out at least which patient cohort is more likely to benefit from this procedure. Methods: A case-control study was conducted on 221 patients with ejection fraction (EF) ≤0.35 and New York Heart Association (NYHA) class III or IV, who received CABG + SVR or CABG alone from 1998 to 2008. Comparisons were made between CABG + SVR and CABG alone within two groups of patients: group 1 (preoperative left ventricular end-systolic volume index [LVESVI] <80 mL/m2, n = 127) and group 2 (preoperative LVESVI ≥80 mL/m2, n = 94). Outcomes included improvement in EF, NYHA class, readmissions, and survival. Results: Patients in either group receiving SVR achieved significant LVESVI reduction postoperatively (p < 0.001). In group 1, EF improvement (defined as over.05 improvement in EF) was observed in 53.7% of CABG + SVR patients compared with 48.5% for CABG patients (p 0.570). A similar percentage of patients improved to NYHA class I or II (63.0% for CABG + SVR versus 55.9% for CABG, p = 0.430). Readmissions after CABG + SVR were 27.8% compared with 38.2% after CABG (p = 0.225). There was no difference in survival between CABG + SVR and CABG (p = 0.709). In group 2, the CABG + SVR patients showed greater EF improvement (55.6% versus 30.8%, p = 0.020) and were more likely to improve to NYHA class I or II (58.3% versus 36.5%, p = 0.044). Readmissions were fewer for the CABG + SVR patients than for the CABG patients (30.6% versus 57.7%, p = 0.012). CABG + SVR yielded better survival than did CABG (p = 0.031). Conclusions: Patients with much advanced LVESVI are more likely to benefit from surgical ventricular restoration, and this surgical procedure still holds its ground in the treatment of ischemic cardiomyopathy. © 2013 The Society of Thoracic Surgeons.

Liu, Z.; Department of Cardiovascular Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Rd, Shanghai, 200025, China; email:pieero@sina.com