[1]马浩 张世成 宋仰午 黄思源 赵栋 凤玮.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[J].心血管病学进展,2023,(5):465.[doi:10.16806/j.cnki.issn.1004-3934.2023.05.019]
　MA Hao,ZHANG Shicheng,SONG Yangwu,et al.Surgical Effects of Coronary Artery Bypass Grafting Alone for Patients with Left Ventricular Aneurysm:A Retrospective Cohort Study[J].Advances in Cardiovascular Diseases,2023,(5):465.[doi:10.16806/j.cnki.issn.1004-3934.2023.05.019]
点击复制

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()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2023年5期
页码:
465
栏目:
论著
出版日期:
2023-05-25

文章信息/Info

Title:
Surgical Effects of Coronary Artery Bypass Grafting Alone for Patients with Left Ventricular Aneurysm:A Retrospective Cohort Study
作者:
马浩 张世成 宋仰午 黄思源 赵栋 凤玮
(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 )
Author(s):
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)
关键词:
左心室室壁瘤; 冠状动脉旁路移植术; 左室射血分数; 左心室舒张末期内经; 二尖瓣反流
Keywords:
Left ventricular aneurysm; Coronary artery bypass grafting; Left ventricular ejection fraction; Left ventricle end-diastolic dimension; Mitral regurgitation
DOI:
10.16806/j.cnki.issn.1004-3934.2023.05.019
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（MACCEs）。Kaplan-Meier分析评估患者免于MACCEs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MACCEs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MACCEs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MACCEs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。
Abstract:
Objective The aim of this study was 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(MACCEs). Kaplan-Meier analysis was performed to evaluate MACCEs-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 was 95.5% and 91.6%, and the MACCE s-free survival was 94.6% and 92.1%,respectively. Mitral regurgitation(MR=2+or3+grade) increased the risk of MACCEs(P=0.021) and mortality(P=0.007),and lower LVEF(＜40%) also increased the risk of MACCEs(P=0.002). Conclusion The treatment of CABG alone for LVA is effective,and the mid-term follow-up results after surgery are satisfactory

参考文献/References:


[1] Antunes PE,Silva R, Ferr?o de Oliveira J,et al. Left ventricular aneurysms:early and long-term results of two types of repair [J]. Eur J Cardiothorac Surg,2005,27(2):210-215.

[2] Bax JJ,van der Wall EE,Harbinson M. Radionuclide techniques for the assessment of myocardial viability and hibernation [J]. Heart,2004,90(suppl 5):v26-v33.

[3] Eagle KA,Guyton RA,Davidoff R,et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery) [J]. Circulation,2004,110(14):e340-e437.

[4] Athanasuleas CL,Stanley AW Jr,Buckberg GD. Restoration of contractile function in the enlarged left ventricle by exclusion of remodeled akinetic anterior segment:surgical strategy,myocardial protection,and angiographic results [J]. J Card Surg,1998,13(6):418-428.

[5] Athanasuleas CL,Buckberg GD,Stanley AW,et al. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation [J]. J Am Coll Cardiol,2004,44(7):1439-1445.

[6] Menicanti L,Castelvecchio S,Ranucci M,et al. Surgical therapy for ischemic heart failure: a single-center experience with surgical anterior ventricular restoration[J]. J Thorac Cardiovasc Surg,2007,134(2):433-441.

[7] Jones RH,Velazquez EJ,Michler RE,et al. Coronary bypass surgery with or without surgical ventricular reconstruction[J]. N Engl J Med ,2009,360(17):1705-1717.

[8] Thygesen K,Alpert JS,Jaffe AS,et al. Fourth universal definition of myocardial infarction (2018) [J]. J Am Coll Cardiol,2018,72(18):2231-2264.

[9] Antunes MJ,Antunes PE. Left-ventricular aneurysms:from disease to repair[J]. Expert Rev Cardiovasc Ther,2005,3(2):285-294.

[10] Sui Y,Teng S,Qian J,et al. Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm [J]. J Int Med Res,2019,47(1):244-251.

[11] Filsoufi F,Aklog L,Byrne JG,et al. Current results of combined coronary artery bypass grafting and mitral annuloplasty in patients with moderate ischemic mitral regurgitation [J]. J Heart Valve Dis,2004,13(5):747-753.

[12] di Donato M,Frigiola A,Menicanti L,et al. Moderate ischemic mitral regurgitation and coronary artery bypass surgery:effect of mitral repair on clinical outcome[J]. J Heart Valve Dis,2003,12(3):272-279.

[13] Miller DC. Ischemic mitral regurgitation redux —To repair or to replace?[J]. J Thorac Cardiovasc Surg,2001,122(6):1059-1062.

[14] Song Y,Hu S,Sun H, et al. Results of left ventricular reconstruction with and without mitral vlve surgery[J]. Ann Thorac Surg,2020,109(3):753-761.

[15] Lundblad R,Abdelnoor M,Svennevig JL. Surgery for left ventricular aneurysm:early and late survival after simple linear repair and endoventricular patch plasty [J]. J Thorac Cardiovasc Surg,2004,128(3):449-456.

相似文献/References:

[1]齐弘炜,袁彪.中国常用动脉化冠状动脉旁路移植术的通畅率及疗效[J].心血管病学进展,2015,(5):559.[doi:10.3969/j.issn.1004-3934.2015.05.009]
　QI Hongwei,YUAN Biao.Effects and Patency of Coronary Artery Bypass Grafting Used in China[J].Advances in Cardiovascular Diseases,2015,(5):559.[doi:10.3969/j.issn.1004-3934.2015.05.009]
[2]马琛 陈少敏 崔鸣.冠状动脉慢性完全闭塞病变治疗研究进展[J].心血管病学进展,2020,(4):333.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.001]
　MA Chen,CHEN Shaomin,CUI Ming.Treatment in Patients with Coronary Chronic Total Occlusion[J].Advances in Cardiovascular Diseases,2020,(5):333.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.001]
[3]奚云萍 臧雁翔 李为民.临床SYNTAX计分及其衍生计分在冠心病血运重建预后中的应用价值[J].心血管病学进展,2020,(5):452.[doi:10.16806/j.cnki.issn.1004-3934.2020.05.004]
　XI Yunping,ZANG Yanxiang,LI Weimin.Value of Clinical SYNTAX Score and Its Derivative Score in Prognosis of Coronary Artery Disease with Revascularization[J].Advances in Cardiovascular Diseases,2020,(5):452.[doi:10.16806/j.cnki.issn.1004-3934.2020.05.004]
[4]孙一博 孙莉萍 董建增.血管炎的冠状动脉风险及手术治疗进展[J].心血管病学进展,2020,(8):821.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.010]
　SUN YiboSUN LipingDONG Jianzeng.Coronary Risk and Progress in Surgical Therapy of Vasculitis[J].Advances in Cardiovascular Diseases,2020,(5):821.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.010]
[5]程悦 孟维鑫 康凯.被动选择还是主动获取？——谈“No-Touch”大隐静脉获取术的产生及研究进展[J].心血管病学进展,2020,(9):934.[doi:10.16806/j.cnki.issn.1004-3934.2020.09.012]
　CHENG Yue,MENG Weixin,KANG Kai.Passive Selection or Active Accessthe Emergence and Research Progress of "No-touch" Technique for Great Saphenous Vein Graft[J].Advances in Cardiovascular Diseases,2020,(5):934.[doi:10.16806/j.cnki.issn.1004-3934.2020.09.012]
[6]赵沐华 周帆 穆军升.冠状动脉旁路移植术后高敏心肌肌钙蛋白水平与预后危险因素评估价值的临床研究进展[J].心血管病学进展,2024,(11):989.[doi:10.16806/j.cnki.issn.1004-3934.2024.11.007]
　ZHAO Muhua,ZHOU Fan,MU Junsheng.Evaluation Value of High-Sensitivity Troponin Levels and Prognostic Risk Factors After Coronary Artery Bypass Grafting[J].Advances in Cardiovascular Diseases,2024,(5):989.[doi:10.16806/j.cnki.issn.1004-3934.2024.11.007]

更新日期/Last Update: 2023-06-29