南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (05): 681-.

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左心室室壁瘤患者行左室成形术与单纯冠脉旁路移植术的中远期疗效对比

申磊磊,汪成,王嵘,肖苍松,吴扬,王瑶,龚志云,郭鹏飞,赵海智,高长青   

  • 出版日期:2016-05-20 发布日期:2016-05-20

Surgical ventricular restoration versus isolated coronary artery bypass grafting for left ventricular aneurysm: comparison of mid- to long-term outcomes

  • Online:2016-05-20 Published:2016-05-20

摘要: 目的评价左心室室壁瘤(left ventricular aneurysm, LVA)患者分别行左室成形术(surgical ventricular restoration, SVR)及 单纯冠脉旁路移植术(coronary artery bypass grafting, CABG)的中远期疗效。方法回顾性分析1997年1月~2012年12月在我 中心诊断为LVA的205例患者资料,其中行SVR115例,行单纯CABG90例,采用1∶1配对方法,以术前超声心动图指标(室壁瘤 大小、左室收缩末期容积指数LVESVI、左室射血分数LVEF)及EuroSCORE危险因素为配对标准,筛选32对纳入研究。比较两 组患者围术期及术后1年、3年、5年心脏结构及功能变化、生存率及MACCEs发生率的差异。结果与单纯CABG对比,SVR术 后心脏超声指标(左室内径LVEDD、左室收缩末期容积LVESV、LVESVI、左室舒张末期容积LVESDV、左室舒张末期容积指数 LVEDVI)较术前明显减小,LVEF明显增加,NYHA分级明显改善;CABG术后仅LVEDD及LVEF较术前有所改善,随时间推 移,两组心脏超声指标均呈上升趋势,组间差异逐渐缩小,并在术后5年差异无统计学意义(P>0.05)。两组在中远期生存率及 MACCEs事件发生率方面差异无统计学意义(P>0.05)。结论对于LVESVI小于60 mL/m2的LVA患者,与单纯CABG对比, SVR并未减少MACCEs事件发生率,也未明显提高中远期生存率。

Abstract: Objective To compare the mid- to long-term outcomes of patients receiving isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) plus CABG for left ventricular aneurysms. Methods The clinical data were retrospectively analyzed in 205 patients with left ventricular aneurysms admitted to our hospital between January, 1997 and December, 2012, including 115 patients receiving SVR plus CABG and 90 undergoing isolated CABG. By matching preoperative echocardiographic parameters including aneurysm size, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVI) and EuroSCORE risk factors, 32 patients receiving SVR plus CABG and another 32 with isolated CABG were enrolled in this study. The patients were compared for survival rates, major adverse cardiac or cerebrovascular events (MACCEs), left ventricular geometry and function at 1, 3 and 5 years of follow-up. Results Compared with the patients receiving isolated CABG, those receiving SVR and CABG showed greater improvements in echocardiographic parameters and NYHA functional class. The differences in the echocardiographic parameters between the two groups gradually reduced with time and became comparable at 5 years after the operation (P>0.05). No significant difference was found in the mid- to long-term survival or the incidence of MACCEs between the two groups (P>0.05). Conclusion Compared with isolated CABG, SVR plus CABG does not reduce the incidence of MACCEs or improve the midto long-term survival rate of patients with left ventricular aneurysm with a LVESVI <60 mL/m2.