冠状动脉旁路移植术联合左心室成形术治疗冠心病心力衰竭伴左心室室壁瘤患者的远期结果  

Long-term Outcome After Coronary Artery Bypass Graft With Surgical Ventricular Reconstruction in Coronary Artery Disease Patients With Congestive Heart Failure and Left Ventricular Aneurysm

作　　者：杨滔 袁昕 李宝童 高伟 杜茗 杨研 潘世伟 赵世华 孙寒松 陆敏杰 YANG Tao;YUAN Xin;LI Baotong;GAO Wei;DU Ming;YANG Yan;PAN Shiwei;ZHAO Shihua;SUN Hansong;LU Minjie(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院、成人外科中心,北京市100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院、磁共振影像科,北京市100037

出　　处：《中国循环杂志》2023年第3期291-298,共8页Chinese Circulation Journal

基　　金：国家自然科学基金(81971588);北京自然科学基金(7204289);中国医学科学院重点实验室建设研究项目(2019PT310025)。

摘　　要：目的:在有慢性心力衰竭(心衰)症状的冠心病伴左心室室壁瘤患者中,探讨在冠状动脉旁路移植术(CABG)的基础上行左心室成形术(SVR)能否进一步改善患者的长期预后。方法:于2010年5月至2013年5月连续纳入130例慢性心衰症状明显的冠心病伴左心室室壁瘤患者,分为CABG+SVR组(n=65)与单纯CABG(I-CABG)组(n=65)。所有患者于术前1个月内行延迟钆增强心脏磁共振成像(LGE-CMR)检查,用国际通用的17节段分析法评估患者的瘢痕心肌及心功能。对所有患者通过门诊或电话进行随访,了解其症状和心功能改善情况以及心衰再入院和其他心血管事件的发生情况。采用Cox模型分析影响患者预后的危险因素,采用Kaplan-Meier生存分析比较两组患者的长期生存率。结果:两组患者的基线临床特征、左心室功能和心肌LGE情况均相似。与I-CABG组相比,CABG+SVR组体外循环时间[(116.0±36.2)min vs.(100.3±23.9)min,P=0.004]和机械通气时间[23(17,37)h vs.20(15,24)h,P=0.005]均明显延长。平均随访(127.3±12.6)个月期间,两组患者的症状和心功能均明显改善,CABG+SVR组改善更明显。CABG+SVR组心衰再入院的发生率明显低于I-CABG组(3.1%vs.20.6%,P=0.002),但两组的死亡率差异无统计学意义(1.6%vs.4.8%,P=0.600)。Cox多因素分析显示,手术策略是心衰再入院的独立危险因素(CABG+SVR vs.I-CABG:HR=0.072,95%CI:0.015~0.340,P=0.001),CABG+SVR组无心衰再入院及其他心血管事件的生存率明显高于I-CABG组(89.1%vs.66.7%,P=0.003)。结论:在慢性心衰症状明显的冠心病伴左心室室壁瘤患者中,与I-CABG相比,CABG+SVR能够进一步改善患者的心功能及临床症状,显著降低心衰再入院的发生风险,改善患者的长期预后。Objectives:To compare the long-term effects of coronary artery bypass graft(CABG)with surgical ventricular reconstruction(SVR)versus isolated CABG(I-CABG)in coronary artery disease patients with chronic heart failure(CHF)and left ventricular aneurysm.Methods:A total of 130 consecutive patients with CHF and left ventricular aneurysm were enrolled from May 2010 to May 2013,including 65 patients with CABG+SVR(CABG+SVR group)and 65 patients undergoing I-CABG(I-CABG group).All patients received late gadolinium enhancement cardiovascular magnetic resonance imaging(LGE-CMR)within one month prior to surgery.Patients were followed up through outpatient service or telephone call to record their symptom status,readmission due to heart failure,cardiac function changes and occurrence of other cardiovascular events.Cox proportional hazard regression model was used to analyze the predictors of outcome.Kaplan Meier survival analysis was used to compare the long-term survival rate between the two groups.Results:Baseline characteristics,left ventricular function and LGE were similar between the two groups.Patients in CABG+SVR group experienced longer cardiopulmonary bypass time([116.0±36.2]min vs.[100.3±23.9]min,P=0.004)and ventilation time(23[17,37]h vs.20[15,24]h,P=0.005)than patients in the I-CABG group.During a mean followup of(127.3±12.6)months,the clinical symptoms and cardiac function of the two groups were significantly improved,and the improvement was more significant in CABG+SVR group than in I-CABG group.Patients in CABG+SVR group had fewer rehospitalizations for heart failure than patients in I-CABG group(3.1%vs.20.6%,P=0.002),but death rate was not significantly different between the two groups(1.6%vs.4.8%,P=0.600).Cox proportional hazard regression model analysis showed the surgical strategy was a significant predictor of rehospitalizations for heart failure(CABG+SVR vs.I-CABG:HR=0.072,95%CI:0.015-0.340,P=0.001).The cumulative cardiovascular events-free survival rate was significantly higher in CABG+SVR patients t

关 键 词：冠状动脉旁路移植术 延迟钆增强心脏磁共振成像 左心室室壁瘤 左心室成形术 慢性心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]