单纯冠状动脉旁路移植术治疗左心室室壁瘤的回顾性队列研究  

Surgical Effects of Coronary Artery Bypass Grafting Alone for Patients with Left Ventricular Aneurysm:A Retrospective Cohort Study

作　　者：马浩[1] 张世成 宋仰午 黄思源 赵栋 凤玮[1] MA Hao;ZHANG Shicheng;SONG Yangwu;HUANG Siyuan;ZHAO Dong;FENG Wei(Department of Cardiac Surgery,Fuwai Hospital,National Clinical Research Center for Cardiovascular Disease,National Center of Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心国家心血管疾病临床医学研究中心,阜外医院心外科,北京100037

出　　处：《心血管病学进展》2023年第5期465-469,共5页Advances in Cardiovascular Diseases

摘　　要：目的评估左心室室壁瘤患者单纯行冠状动脉旁路移植术(CABG)治疗的效果,并探讨不良事件的潜在危险因素。方法回顾性分析2017年7月—2021年3月于中国医学科学院阜外医院单纯行CABG治疗的121例左心室室壁瘤患者的临床资料。研究终点为主要不良心脑血管事件(MACCE)。Kaplan-Meier分析评估患者免于MACCE的生存率,亚组分析探讨影响患者预后的危险因素。结果平均随访时间为(27.1±14.1)个月,术后左心室舒张末期内径和左室射血分数较术前显著改善。手术死亡率和围手术期心肌梗死发生率为1.5%。1年和2年的总体生存率分别为95.5%和91.6%,免于MACCE的生存率分别为94.6%和92.1%。术前少量及中量的二尖瓣反流(2+或3+级)会增加MACCE的发生风险(P=0.021)和死亡率(P=0.007),左室射血分数<40%也增加了MACCE的发生风险(P=0.002)。结论单纯行CABG治疗左心室室壁瘤是一种可行的方法,术后中期随访结果令人满意。Objective To evaluate the outcome of coronary artery bypass grafting(CABG)alone in patients with left ventricular aneurysm(LVA)and to explore the potential risk factors for adverse events.Methods A total of 121 consecutive patients with LVA underwent CABG alone from July 2017 to March 2021 in Fuwai Hospital,Chinese Academy of Medical Sciences.The endpoint was the major adverse cardiovascular and cerebrovascular events(MACCE).Kaplan-Meier analysis was performed to evaluate MACCE-free survival rate,and subgroup analysis was used to explore risk factors affecting patient prognosis.Results The mean follow-up time was(27.1±14.1)months.Both the postoperative left ventricular end-diastolic dimension and left ventricular ejection fraction(LVEF)were improved significantly than those before surgery.Both operative mortality and the incidence of perioperative myocardial infarction were 1.5%.The overall survival at 1 and 2 years were 95.5%and 91.6%,and the MACCE-free survival were 94.6%and 92.1%,respectively.Mitral regurgitation(MR=2+or 3+grade)increased the risk of MACCE(P=0.021)and mortality(P=0.007),and lower LVEF(<40%)also increased the risk of MACCE(P=0.002).Conclusion The treatment of CABG alone for LVA is effective,and the mid-term follow-up results after surgery are satisfactory.

关 键 词：左心室室壁瘤 冠状动脉旁路移植术 左室射血分数 左心室舒张末期内径 二尖瓣反流 

分 类 号：R732.1[医药卫生—肿瘤]