左心室成形术临床应用评价

Clinical evaluation on left ventricular reconstruction (Dor procedure)

目的 总结左心室成形术治疗缺血性心肌病的临床应用经验。方法 1998至 2 0 0 0年意大利米兰SanDonato医院收治合并室壁瘤的缺血性心肌病病人 4 6例。在低温体外循环下完成冠状动脉旁路移植远端吻合后切开心尖部室壁瘤 ,沿室壁瘤边缘行心室内环缩成形术 (Dor手术 ) ,之后用补片或直接闭合室壁瘤壁 ,重塑左室形态。结果 围术期死亡 7例 ,死亡率为 15 2 % ;术后左室收缩末期及舒张末期容积均显著降低 (P <0 0 0 1) ;肺动脉压亦显著下降 (P <0 0 5 )。中期随访生存率为 71 8%。

Objective: To summarize up our experiences and make an evaluation on left ventricular reconstruction (Dor procedure) for treatment in ischemic cardiomyopathy. Methods: Forty six patients with ischemic cardiomyopathy and left ventricular aneurysm composed the study group. 25 patients were in NYHA class IV. This surgical approach consists of left ventricular reconstruction (Dor Procedure) combined with endoventricular plasty and coronary artery bypass grafting (CABG). Results: Global perioperative mortality rate was 15 2%, it was 20% in the patients with EF <0 30 and 11 5% in the patients with EF ≥0 30. End diastolic and end systolic volumes decreased significantly after surgery (P<0 001). Pulmonary pressure decreased significantly (P<0.05). Mid term overall survival rate of 71 8% seems promising in this series of patients. Conclusion: Although a longer term follow up is mandatory, we believe that this innovative procedure is highly effective in the reduction of the transverse diameter and contributes to a more physiologic correction of the left ventricular shape consequently, leads to a better function.