左心室收缩功能低下冠心病病人冠状动脉旁路移植术的中远期效果

目的　总结并分析左心室收缩功能低下冠心病病人行冠状动脉旁路移植手术(CABG)的中、远期效果。方法　34例左心室射血分数(LVEF)低于0 30且不伴左心室室壁瘤的冠状动脉粥样硬化心脏病病人行CABG ,平均年龄(5 8 0±9 4 )岁。冠状动脉造影显示LVEF为0 15～0 30 ,平均0 2 7±0 0 4 ,其中2支病变3例,3支病变31例(包括左主干病变4例)。超声心动显示左心室舒张末直径(LVDD)平均为(6 1 5±8 9)mm ,LVEF平均0 2 8±0 0 7。心功能分级平均为2 9±0 7。体外循环下手术2 6例,非体外循环常温手术(OPCAB) 8例。每例旁路移植2～6支,平均(3 9±0 9)支。随访率94 1% ,随访时间平均(3 5±1 9)年。结果　无手术死亡。早期主要并发症为心功能不全。所有病人心绞痛症状明显减轻,左心室舒张末直径平均(5 5 2±7 1)mm ,LVEF平均0 4 7±0 11。心功能分级平均1 9±0 3。以上指标与术前进行统计学比较,差异均具统计学意义。随访3年生存率为91 9% ,5年生存率为85 7%。5年免除心绞痛为81 3% ,心功能分级为1～3级,平均1 4±0 6。结论　伴左心室收缩功能低下的CABG病人的中、远期疗效满意,充分的术前准备是手术成功关键。     

左心室室壁瘤的外科治疗

目的评估心肌梗死后左心室室壁瘤(post-infarct left ventricular aneurysm,LVA)行左心室重建术和线性修补术的治疗效果,总结室壁瘤的外科治疗经验。方法 2004年5月至2011年12月上海交通大学医学院附属仁济医院心血管外科共收治47例LVA患者;行左心室重建术25例(男21例、女4例),线性修补术18例(男14例、女4例),直接缝闭术4例(男3例、女1例)。同期行冠状动脉旁路移植术42例。术后通过电话及门诊随访6~24个月,患者均行超声心动图复查左心室射血分数(LVEF)、生活质量及活动能力。结果左心室重建术组术后LVEF较术前明显改善(49.2%±13.6%vs.32.5%±12.9%,P0.05),线性修补术组术后LVEF同样较术前改善(47.5%±11.6%vs.36.9%±11.6%,P0.05);线性修补术组死亡1例,病死率5.5%;左心室重建术组死亡1例,病死率4.0%;直接缝闭术组无死亡;全组总病死率4.2%。结论线性修补术或左心室重建术治疗心脏室壁瘤均可取得满意效果,根据患者个体情况制订合理方案,能够最大程度恢复左心室功能,近远期治疗效果良好。     

非体外循环冠状动脉旁路移植术患者术中急性心功能失代偿的危险因素

目的 筛选非体外循环冠状动脉旁路移植术(OPCABG)患者术中发生急性心功能失代偿的危险因素.方法 选择本院2007年11月至2009年2月行OPCABG的患者2379例,记录术前、术中与急性心功能失代偿可能有关的因素.根据是否发生急性心功能失代偿,分为2组:急性心功能失代偿组和非急性心功能失代偿组.采用1ogistic多元回归分析,筛选发生急性心功能失代偿的危险因素.结果 术中发生急性心功能失代偿368例(发生率15.5%),无一例患者死亡.logistic多元回归分析显示,室壁瘤、术中房颤、术中频发性室性期前收缩、术前射血分数＜40%、术前室性期前收缩、合并瓣膜病、心肌梗死史、入室心动过速、急诊手术、左主干病变为术中发生急性心功能失代偿的危险因素.结论 术前合并室壁瘤、瓣膜病变、左主干病变、心肌梗死史、术前室性期前收缩、射血分数＜40%,术中房颤、频发性室性期前收缩、入室心动过速和急诊手术为OPCABG患者术中发生急性心功能失代偿的危险因素.     

冠心病合并左室室壁瘤行冠状动脉旁路移植术未同期行左心室成形术的疗效分析

目的 分析冠心病合并左室室壁瘤形成患者仅行冠状动脉旁路移植术（CABG）但未同期行左心室成形术的疗效。 方法 2008年1月至2012年12月武汉亚洲心脏病医院收治冠心病合并室壁瘤患者共105例,术中探查发现室壁瘤边界欠清或活动欠佳或无明显矛盾运动而未处理室壁瘤患者共74例,其中男59例,女15例;年龄 （60.96±9.09） 岁。冠状动脉造影显示：单支血管病变5例,双支病变10例,3支病变45例,左主干＋3支病变14例。术中发现30例室壁瘤界限不清,29例心尖室壁变薄、室壁瘤不明显,15例室壁瘤未见明显的矛盾运动、心尖部质地较厚。所有患者均行冠状动脉旁路移植术。在体外循环下手术62例,非体外循环下手术12例。70例采用左乳内动脉吻合于左前降支,2例行左前降支内膜剥脱术。因二尖瓣中-重度反流行二尖瓣成形术3例,二尖瓣置换术2例;因合并主动脉瓣重度狭窄同期行主动脉瓣置换术1例。 结果 术后因恶性心律失常、缺血、缺氧性脑病死亡2例 （2.7%）;因低心排血量、围术期心肌梗死、恶性心律失常等行主动脉内球囊反搏 （IABP） 辅助6例。术后随访70例,随访时间24～60 （43±12） 个月。随访期间发现心室内血栓形成8例,其中5例服用华法林1年内血栓消失,无1例发生血栓脱落栓塞事件。超声心动图检查提示：室壁瘤消失18例 （25.7%）。出院时、术后6个月、1年射血分数较术前明显增高 （术后6个月与术前比较：44%±6% vs. 39%±5%）,左心室舒张期末内径 ［术后6个月与术前比较：（54.37±6.28） mm vs. （59.24±6.24）mm］、左心室收缩期末内径与术前比较明显缩小 （P＜0.01）。但随着时间延长,左心室舒张期末内径、左心室收缩期末内径较出院时逐渐增大。 结论 对于合并室壁瘤的冠心病患者,根据术中探查实际情况未行左心室成形术仅行冠状动脉旁路移植术,术后射血分数、左心室舒张期末内径、左心室收缩期末内径均较术前明显改善,但术后心室扩大呈进行性发展。     

心外膜射频消融对左心室室壁瘤相关室性心律失常的早期疗效观察

左心室室壁瘤是冠状动脉粥样硬化性心脏病急性心肌梗死后的严重并发症之一,室壁瘤术后发生恶性室性心律失常导致心源性猝死的问题也逐渐引起关注.术后30 d和术后5年猝死占室壁瘤术后总死亡原因的29.6％和36.8％[1].射频消融是治疗室性心律失常的有效手段[2].2009年6月至2011年3月,我们对25例左心室室壁瘤的患者施行了非体外循环冠状动脉旁路移植术(OPCAB)同期左心室室壁瘤缝缩和心外膜射频消融术,取得了良好效果,现报告如下.     

左心室巨大室壁瘤手术治疗的中远期随访研究

目的了解左心室巨大室壁瘤手术治疗的中、远期效果. 方法采用多次信访、电话随访和门诊复查相结合的方法, 对58例左心室巨大室壁瘤行手术治疗后生存的56例患者中的49例进行了随访,随访率87.5% ,随访时间(47.6±22.4)个月,随访时间最长者90.0个月. 结果患者随访期内死亡10例,5年生存率为63.7%.术后患者左心室舒张末径有明显缩小;术后29.0个月左心室射血分数与术前相比,有显著提高.所有患者均无再次心肌梗死发生,心绞痛复发6例,程度较术前减轻.NYHA心功能分级由术前的(2.5±0.7 )级转为(1.3±0.5)级.统计分析显示,左心室舒张末径大于70 mm 及左心室射血分数小于35%,为独立相关危险因素. 结论左心室巨大室壁瘤手术治疗患者,中、远期疗效较好,绝大部分无心绞痛发生,生活质量提高,生存率与国外报道相似.     

三维超声评价Dor法切除左心室室壁瘤对左心室形态和功能的影响

目的使用三维超声建立一种新的左心室形态定量指标,评价Dor法室壁瘤切除术对左心室形态和功能的影响。方法2003年5月至2004年4月,18例冠心病病人,根据术前二维心脏超声诊断,分为室壁瘤组、左心室扩大组和正常对照组,每组6例。比较3组病人术前、术后心功能和心室三维形态指数(心室锥度,C值)的变化。结果3组均无手术死亡。正常对照组术前、术后的EF、左心室容积、形态没有明显变化。室壁瘤组术后左心室容积明显减少,EF从术前0.43±0.06提高到术后0.54±0.08(P=0.02);左心室三维形态更接近类圆锥体(C值接近于1),舒张心室锥度从术前0.36±0.04提高到术后0.56±0.04(P=0.02),收缩末心室锥度从术前0.42±0.03提高到术后0.60±0.05(P=0.03)。室壁瘤组心室形态改善显著。结论Dor法能有效改善左心室室壁瘤病人的心功能和心室形态。三维超声是进行心室形态定量研究的精确、有效、经济的新手段。     

110例冠状动脉搭桥手术临床分析

冠状动脉搭桥手术 (ＣＡＢＧ)是目前治疗冠心病最有效和最重要的方法之一 ,我们自 1997年 7月至 1998年 7月共为 130余例病人施行冠状动脉搭桥手术 ,现将资料完整的 110例总结报道如下。临床资料　全组病人男 89例 ,女 2 1例 ;年龄 36～ 75岁 ,平均 (5 9 2± 8 1)岁。有心肌梗死史者 70例 (6 3 6 % ) ,合并左心室室壁瘤 2 2例 (2 0 % )、合并中度二尖瓣关闭不全、二尖瓣关闭不全并重度狭窄、先天性心脏病房间隔缺损各 1例 ,6 0例高血压 ,5 9例有吸烟史 ,2 3例糖尿病 ,1例主动脉瓣置换术后 1年。单支血管病变 3例 ,2支血管病变 10例 ,3支血管…     

前降支弥漫病变27例的外科处理

20 0 1年我们完成的冠状动脉旁路移植术 (ＣＡＢＧ) 2 5 1例中前降支弥漫病变 2 7例 ,现总结处理方法和经验如下。临床资料　 2 7例中男 16例 ,女 11例。平均年龄 ( 6 5 3±12 6 )岁 ,占同期ＣＡＢＧ术的 10 8%。其中合并糖尿病 16例 ,高血压 10例 ,前壁心肌梗死 6例 ,前壁心尖部室壁瘤形成 2例 ,合并二尖瓣关闭不全 2例。术前射血分数 (ＥＦ)平均0 5 6± 0 2 2。术前冠状动脉造影显示前降支管径明显细小 ,多处狭窄、钙化者共 2 1例。手术方法　全组均在全麻体外循环下进行 ,平均搭桥( 3 8± 3 2 )支 ,行室壁瘤切除 2例 ,二尖瓣成形 2…     

OPCAB同时行左心室室壁瘤缝缩术206例

目的 尝试非体外循环冠状动脉旁路移植术同时进行室壁瘤缝缩术，并评估其疗效。方法 选取2001年1月至2006年6月间206例左室室壁瘤病人进行手术。病人术前均存在心绞痛症状，同时伴心功能不全或室性心律失常。心功能为Ⅱ-Ⅳ级。术前射血分数平均0．41±0．06，左心室舒末内径平均（57．4±6．8）mm。不停跳下进行室壁瘤线性缝缩，比较术前及术后相关心功能指标。结果 住院死亡1例，病死率0．5％（1／206例）。平均移植血管（2．9±0．9）支。复查时所有病人均无症状。心功能及射血分数均显著提高（P〈0．001）。左心室舒末内径显著缩小（P〈0．001）。结论 在非体外循环冠状动脉旁路移植同时进行室壁瘤缝缩术是可行的，手术死亡率低、并发症少。术后早期心功能、自觉症状及生活质量均显著改善。远期疗效尚需观察。     

Efficacy of additional Dor approach to coronary bypass grafting in severe left ventricular dysfunction with large akinetic area

Between January 1994 and August 1999, we experienced 16 cases of coronary artery bypass grafting (CABG) in severe left ventricular dysfunction with left ventricular ejection fraction (LVEF) < or = 40%. Four had additional endoventricular patch plasty in large postinfarction akinetic scars, the so-called Dor approach, to CABG (group D). Eleven had only CABG, or CABG and mitral annuloplasty (group C). One had linear repair after the resection of the left ventricular aneurysm. One died of sustained low output syndrome 5 months after the operation in group C. Fractioning shortening and left ventricular diastolic diameter were not changed after the operation in group C. On the other hand, in group D, there were no complications after the operation, LVEF was significantly improved from 31.5 +/- 4.9% to 62.5 +/- 5.9% (p < 0.01) and the left ventricular end-diastolic volume index was reduced from 118 +/- 23 ml/m2 to 74 +/- 12 ml/m2 (p < 0.01). The Dor approach is considered to be a safe and effective additional procedure to CABG in severe patients with a large akinetic antero-septal segment.     

Off-pump coronary artery bypass grafting/beating coronary artery bypass grafting for a patient with low left ventricular ejection fraction

Beating coronary artery bypass grafting could be performed for a 47-year-old man with left ventricular ejection fraction (LVEF) of 9.3%. Post-operative LVEF was improved to 51.6%. Conventional coronary artery bypass grafting (CABG) used to be contraindicative for patients with LVEF below 20%. Recently, such patients are involved to indication of off-pump CABG (OPCAB) or beating CABG, because we consider OPCAB are lower complications than conventional CABG. We were able to bypass the circumflex for the patient while we had been used percutaneous cardio-pulmonary support (PCPS). We could perform beating coronary artery bypass grafting for a patient of the low LVEF.     

Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction

Patients with severe left ventricular systolic dysfunction (LVSD) undergoing coronary artery bypass grafting (CABG) have an increased risk for morbidity and mortality. The purpose of this study was to assess the association of pre-CABG right ventricular (RV) function with outcome for patients with severe LVSD. We performed a retrospective evaluation of 41 patients with severe LVSD (left ventricular ejection fraction [LVEF] < or =25%) scheduled for nonemergent CABG. Data were obtained from review of medical records, transesophageal echocardiography tapes, and phone interview. The pre- and post-cardiopulmonary bypass (CPB) LVEF and the RV fractional area of contraction (RVFAC) were calculated by using intraoperative transesophageal echocardiography. Group 1 patients had an RVFAC < or =35% (n = 7), whereas Group 2 patients had RVFAC >35% (n = 34). The durations of mechanical ventilation and of intensive care unit and hospital stays are presented as the median. Pre-CABG LVEF was similar between Groups 1 and 2 (15.8% +/- 3.3% versus 17.8% +/- 3.9%). Compared with Group 2, Group 1 patients required greater duration of mechanical ventilation (12 days versus 1 day; P < 0.01), longer intensive care unit (14 versus 2 days; P < 0.01) and hospital (14 versus 7 days; P = 0.02) stays, had a more frequent incidence and severity of LV diastolic dysfunction, and had a smaller change in LVEF immediately after CPB (4.1% +/- 8.3% versus 12.5% +/- 9.2%; P = 0.03). All Group 1 patients died of cardiac causes within 2 yr of surgery; five died during the same hospital admission. Three Group 2 patients died: one of colon cancer at 18 mo after CABG and two of cardiac causes 24 and 48 mo after surgery. A fourth patient was awaiting cardiac transplantation 4 yr after surgery. The remaining Group 2 patients were New York Heart Association Classification I or II. For patients with severe LVSD undergoing CABG, pre-CPB RV dysfunction was associated with poor outcome. Patients with RVFAC >35% had a relatively uneventful perioperative course and good long-term survival, whereas patients with RVFAC < or =35% had a poor early and late outcome. Assessment of RV function is useful to further assess the risk of CABG. IMPLICATIONS: Right ventricular function before cardiopulmonary bypass is associated with poor outcome after coronary artery surgery in patients with poor left ventricular function.     

Aortic valve replacement: a safe and durable option in patients with impaired left ventricular systolic function.

BACKGROUND: The natural history of aortic valve disease associated with ventricular dysfunction is dismal. Aortic valve replacement (AVR) is associated with increased mortality in patients with left ventricular dysfunction and the long-term outcome in these patients is not well-known. We evaluated perioperative outcomes and long-term results in patients with impaired left ventricular systolic function undergoing AVR. METHODS: Retrospective analysis identified 132 consecutive patients with a left ventricular ejection fraction (LVEF)<40% who underwent AVR with or without concomitant coronary artery bypass grafting (CABG) between 1990 and 2003. Patients with other valve pathology were excluded. RESULTS: Ages ranged from 29 to 94 years (mean 63+/-12), and 117 patients (89%) were male. Preoperatively, 82% were in NYHA III-IV. Sixty patients (45%) underwent AVR for severe aortic stenosis (AS) whilst 72 (55%) had aortic insufficiency (AI). In the AS group, the mean LVEF and aortic valve area were 26+/-4% and 0.8+/-0.4 cm(2), respectively. AI patients had a mean LVEF of 27+/-6% and a mean left ventricular end systolic diameter of 52+/-9 mm. Fifty-seven (43%) required concomitant CABG. There were only three perioperative deaths (2.3%) and no strokes. One patient (0.8%) had postoperative renal failure, and one suffered a myocardial infarct. Nine patients (6.9%) required a postoperative IABP. LVEF increased to 29+/-10% and 34+/-12% after six months in the AS and AI groups, respectively. The mean follow-up period was 6.1 years and no differences between the AS and AI groups were observed with respect to either perioperative or long-term outcomes. Overall survival was 96%, 79% and 55% at 1, 5 and 10 years, respectively. CONCLUSIONS: The long asymptomatic course of AS and AI means that many patients have impaired ventricular function at diagnosis. This study demonstrates that AVR in such patients can be performed with low perioperative morbidity and mortality. The outlook after surgery is excellent. A 10-year-survival of 55% compares favourably with heart transplantation and particularly with medical therapy. AVR is a safe, effective and durable option, which should not be denied to patients on the basis of low LVEF alone.     

High myocardial lactate concentration is associated with poor myocardial function prior to cardiopulmonary bypass

AIM: This study was designed to analyse the relationship between myocardial lactate--determined by microdialysis--and hemodynamics during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). METHODS: Twenty consecutive patients with coronary artery disease were enrolled for this prospective, observational study. Microdialysis measurements were performed in the apical region of the heart during periods of 15 to 20 min before, during, and after CPB; hemodynamics and plasma lactate concentrations were determined correspondingly. Correlation analysis revealed a relationship between myocardial lactate concentration and right ventricular ejection fraction at baseline (Spearman's r: 0.6; P=0.02). Patients were thus grouped according to the myocardial lactate concentration at baseline into a high-lactate group (2.5+/-0.7 mmol.l(-1), n=10) and low-lactate group (0.9+/-0.5 mmol.l(-1), n=10). RESULTS: Preoperative left ventricular ejection fraction was not different between the groups (high-lactate group: 53+/-16%; low-lactate group: 57+/-15%; P=n.s.) Patients in the high-lactate-group had a lower stroke volume index (P=0.005) and right ventricular ejection fraction (P=0.04) before, and higher central venous and pulmonary artery pressures (P<0.01) after CPB. Plasma lactate was significantly higher during CPB in the high-lactate-group (P<0.05). No correlation was observed between myocardial and plasma lactate. Six patients in the high-lactate but none in the low-lactate-group needed inotropic support after weaning from CPB (P=0.01). CONCLUSIONS: These data are suggestive of an association between subtle myocardial ischemia--detected by microdialysis--and perioperative myocardial dysfunction in patients undergoing CABG. The microdialysis technique may be a valuable adjunct for monitoring myocardial metabolism during cardiac surgery.     

Coronary artery bypass surgery in patients with severely impaired left ventricular function]

The efficacy and problem of coronary artery bypass grafting (CABG) in patients with severely impaired left ventricular function (left ventricular ejection fraction < or = 30%) were assessed in 27 patients of whom 17 (group 1) underwent emergent CABG and 10 (group 2) elective between Jan 1984 to Aug 1990. As a whole, history of myocardial infarction (24/27, 88.9%), large left ventricular volume with reduced ejection fraction (LVEDVI 126.08 +/- 25.91 ml/m2, LVESVI 93.04 +/- 21.02 ml/m2, LVEF 25.04 +/- 4.75%) and multiple vessel disease with at least one vessel total occlusion (20/27, 74.1%) were characteristically seen in these patients. The patients of group 1 were significantly older (mean 66.12 +/- 5.68 vs 57.10 +/- 8.08, p < 0.01) and needed more frequent preoperative support with IABP (17/17 vs 4/10, p < 0.01). Using Thallium-201 scintigraphy, in 10 patients of group 1 and 9 of group 2, myocardial viability in the proposed bypass area was evaluated before operations. Average 2.37 +/- 0.79 grafts were placed and continuous retrograde cold blood cardioplegia via the coronary sinus was employed for myocardial protection. Two mitral annuloplasty (MAP) for ischemic mitral regurgitation and 2 cryoablation for the treatment of ventricular tachycardia were performed concomitantly. Operative mortality was 47.1% in group 1 and none in group 2 (p < 0.05). Two cases of MAP died, but two cases of cryoablation survived. Postoperative LVEF was improved significantly only in group 2 (p < 0.05), but during the follow-up period of 7 months to 6 years, all 19 survivors expect one remains with NYHA class I or II.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of right ventricular function by intraoperative transesophageal echocardiography for patients with left ventricular dysfunction

We evaluated right and left ventricular function by intraoperative transesophageal echocardiography for the patients with left ventricular dysfunction (left ventricular ejection fraction (LVEF) < or = 40) who underwent isolated coronary artery bypass grafting (CABG). We divided these patients into two groups; group 1 who had difficulty of weaning from cardiopulmonary bypass due to hypotension (n = 8) and group 2 who did not have any difficulty of it (n = 17). Basement characteristics (age, gender, history of myocardial infarction, congestive heart failure, LVEF, severity of the right coronary artery disease) of both groups were not different significantly. Intraoperative characteristics (the number of distal anastomoses, duration of aortic cross-clamp and cardiopulmonary bypass, and bypass to the right coronary artery) were also not different between two groups. However, mean duration of ICU stay and in-hospital mortality were significantly longer and higher in group 1 than group 2. On the other hand, right ventricular systolic function was severely impaired, particularly postoperatively, in group 1 compared with group 2. Right and left ventricular systolic function of group 2 was fairly improved postoperatively. These results may indicate that right ventricular dysfunction is a potent predictor of postoperative morbidity and mortality for the patients with left ventricular dysfunction who undergo isolated CABG.     

实时三维超声心动图测量左心功能评价 冠状动脉搭桥术的效果

目的探讨实时三维超声心动图（RT-3DE）测量左心室整体峰值充盈率（gPFR）、整体峰值射血率（gPER）、左心室射血分数（LVEF）综合评价冠状动脉搭桥术（CABG）的效果。方法采集30例CABG患者（CABG组）术前3天、术后1周、术后1个月和22名正常志愿者（正常对照组）的左心室全容积图像。gPER、gPFR、LVEF通过分析软件获得。比较gPER、gPFR、LVEF在CABG组与正常对照组的差异、CABG手术前后的变化情况,以及在各组各时间点的相关性。结果CABG组的gPER、gPFR、LVEF均较正常对照组显著减低（P〈0.01）。CABG术后1周较术前无显著改变（P〉0.05）;术后1个月较术前及术后1周显著增高（P〈0.01）。相关性分析表明：正常对照组与CABG组术前3天、术后1周、术后1个月gPER与LVEF（r=0.98、0.90、0.96、0.86,P均〈0.01）、gPER与gPFR（r=0.98、0.98、0.98、0.97,P均〈0.01）均相关。结论RT-3DE作为一种新的无创、精确的技术,测量gPER、gPFR、LVEF能综合评价CABG效果。     

The mid-term outcome of geometric endoventricular repair for the patients with ischemic left ventricular dysfunction.

OBJECTIVE: Recent studies have suggested that increased left ventricular (LV) size is a risk factor for perioperative mortality in patients with low ejection fraction (EF) undergoing coronary artery bypass surgery (CABG). We previously presented a new method of LV reconstruction, called geometric endoventricular repair (GER) as representing a physiologically effective repair. The aim of this study is to assess whether GER confers benefits compared to patients undergoing CABG alone. METHODS: Between July 1996 and July 2001, 110 patients with a low EF of less than 35% documented by radionuclide ventriculogram (RNVG) underwent CABG in Austin Hospital, Australia, and were divided into two groups. Group I consisted of 52 patients undergoing isolated CABG. Group II comprised 58 patients undergoing CABG and GER. We compared the two groups in terms of EF, NYHA class, incidence of recurrent heart failure, and mortality. RESULTS: Preoperative EF was 27.7+/-6.1% in group I and 27.4+/-5.7% in group II, respectively (NS), with significant improvement in both groups (33.8+/-13.0% in group I, 35.1+/-13.3% in group II). NYHA class was also significantly improved postoperatively (from 3.3 to 1.8 in group I, and 3.6 to 1.7 in group II). There were 15 patients (28.8%) hospitalized for heart failure in group I, postoperatively, compared to seven patients (10.9%) in group II (p=0.026). Cardiac event-free survival rate at 28 months (mean follow-up) was also significantly higher in group II (88.9% in group II vs. 70.6% in group I, p=0.05). The actuarial survival rate at 31 months (mean follow-up) was 88.2% in group I and 95.3% in group II, respectively (NS). CONCLUSIONS: LV reconstruction along with CABG for ischemic ventricular dysfunction may provide symptomatic and cardiac event free survival benefits, compared to CABG alone.     

激光心肌血运重建术治疗危重冠心病的临床分析

目的总结激光心肌血运重建术(TMLR)治疗心功能低下的冠状动脉粥样硬化性心脏病(冠心病)和冠状动脉旁路移植术(CABG)后患者的早期临床效果. 方法 103例行TMLR的冠心病患者,根据TMLR术前心功能情况和是否做过CABG,分为3组.心功能低下组11例,左心室射血分数(LVEF)<0.40;二次手术组9例,CABG术后行TMLR;对照组83例,LVEF正常. 均在心脏不停跳下行TMLR.术中采用食管超声心动图(TEE)证实营造透壁性孔道.观察术后早期患者临床情况,随访心绞痛和心功能的改善情况. 结果心功能低下组和二次手术组术后心功能低下、心肌梗死、早期并发症的发生与对照组比较无明显差别,3组患者术后心绞痛均较术前明显改善(P＜0.05),LVEF较术前增高(P＜0.05). 结论 TMLR治疗心功能低下和CABG后患者是安全有效的.针对不同患者采用不同的治疗方法,可降低心功能低下和CABG后患者的手术风险.