左心室成形术治疗缺血性心力衰竭  

Surgical ventricular restoration in treating ischemic heart failure

作　　者：孔烨[1] 隋亮[2] 瞿晓红[2] 杭钧彪[2] 沈振亚[1] 

机构地区：[1]苏州大学附属第一医院心血管外科,215006 [2]上海交通大学医学院附属瑞金医院心胸外科,200025

出　　处：《国际心血管病杂志》2008年第3期192-195,共4页International Journal of Cardiovascular Disease

摘　　要：目的:探讨并行循环下采用左心室成形术治疗缺血性心力衰竭的临床技术和经验,并报告中期疗效随访结果。方法:回顾性分析2004年4月至2007年6月,我院心胸外科17例行左心室成形术的缺血性心力衰竭患者的临床资料。其中男性14例,女性3例,平均年龄(64±12.1)岁。既往有心肌梗死史12例,合并缺血性二尖瓣返流10例,合并左心室室壁瘤13例,合并左心室血栓4例。术前左心室射血分数(LVEF)为(29.1±6.4)%。术前心功能NYHA分级Ⅱ级5例,Ⅲ～Ⅳ级12例。17例缺血性心力衰竭的患者中,9例行左心室成形术(冠状动脉旁路术;6例行左心室成形术(冠状动脉旁路术(二尖瓣成形术;2例行单纯左心室成形术。4例合并左心室血栓者同时行左室血栓清除。全组患者均采用常温并行循环、左心引流,不阻断升主动脉,心脏跳动下完成左心室成形术。13例患者采用Dor手术进行左心室成形,4例患者采用改良线性缝合法进行室壁瘤切除(左心室成形。术后患者均接受门诊或电话随访。结果:全组发生手术死亡1例,二次开胸止血1例。存活患者无严重围术期并发症发生。术后随访(12.7±6.1)个月,无失访例。随访期间中1例患者于术后3个月死于严重肺部感染。其余患者均存活,无心血管不良事件发生。术后患者LVEF平均为(42.8±7.2)%,较手术前明显改善(P<0.05)。术后心功能NYHA分级Ⅰ～Ⅱ级9例,Ⅲ级6例(P<0.05)。结论:并行循环下采用左心室成形术治疗缺血性心力衰竭安全可靠,中期随访疗效满意,但其对于患者心功能以及生存率的远期影响,尚有待进一步研究。Objective： To summarize our experience of surgical ventrlcular restoration in treating ischemic heart failure, and to evaluate the mid-term clinical results, Methoas：From April 2004 to June 2007, 17 patients with ischemic heart failure underwent surgical ventricular restoration surgery in our hospital. Among the patients, 14 patients were male and 3 were female, with mean age of （64 ± 12.1） years. Twelve patients had history of myocardial infarction, 10 patients combined with ischemic mitral valve regurgitation, 13 with left ventricular aneurysm, and 4 patients had left ventricular mural thrombi. Preoperative left ventricular ejection fraction （LVEF） was （29. 1 ± 6.4）%. Five patients were in NYHA class Ⅱ , and 12 in class Ⅲ-Ⅳ gr. Surgical ventricular restoration was performed in all patients. Concomitant coronary artery bypass graft（CABG） was performed in 9 patients, and concomitant CABG ＋ mitral valve plasty （MVP） was performed in 6 patients. Left ventricular mural thrombi were removed in 4 patients. All the surgical ventricular geometry restorations were completed in the condition of normo-thermal extracorporeal circulation, left heart venting , aortic no clamping and beating heart technique. Dor technique （endoventricular circular patch plasty ）was used in 13 patients, and modified linear suture technique was applied in 4 patients. All patients were followed up postoperatively by clinic visit or telephone interview. Results：There was 1 perioperative mortality. And 1 reexploration for bleeding. All the survivals were discharged without complications. Follow up was available in all patients in （12.7 ± 6. 1）months. One patient expired of severe pulmonary infection 3 months after surgery. There were no cardiac-related events during the follow- up in all the other patients. The echocardiography data at follow-up showed LVEF was increased to （42.8 ± 7.2） %. A significant improve in NYHA class was observed, class Ⅰ -Ⅱ in 9, and class Ⅲ in 6 patients（P〈0.05�

关 键 词：左心室成形术 缺血性心力衰竭 缺血性心肌病 左心室室壁瘤 

分 类 号：R541.61[医药卫生—心血管疾病]