经皮左心室重建术的单中心初步手术经验

Percutaneous left ventricular restoration:preliminary experience of a single center

目的评价左心室隔离装置Parachute的临床安全性和有效性,并总结初步的手术操作经验。方法同济大学附属第十人民医院心内科2014年3—12月入选并完成6例经皮左心室重建术,并进行3个月的术后随访。结果入选的6例患者均为男性,平均年龄为(59±12)岁,纽约心脏病学会心功能分级均为Ⅱ级以上。心肌梗死发生距手术的平均时间为(9±7)个月。6例患者均成功释放左心室隔离装置,X线曝光时间平均为(13.6±10.4)min。1例患者术后出现左侧伤口血肿,余患者在住院和随访期间无任何严重并发症发生。术后3个月随访时,所有患者的心力衰竭症状均得到缓解,4例患者述偶有胸部异物感。患者的纽约心脏病学会心功能分级均恢复到Ⅰ级,左心室射血分数由0.289±0.058升至0.333±0.034,左心室舒张末期直径由(5.34±0.67)mm降至(5.31±0.62)mm,6min步行距离由(494.0±103.9)m升至(511.0±72.9)m。结论心室重建术是一种安全有效的治疗手段。

Objective To evaluate the safety and efficacy of the percutaneous left ventricular restoration Parachute system and summarize preliminary experience of the operation. Methods Six patients underwent percutaneous left ventricular restoration between March 2014 and December 2014 and were followed up for 3 months. Results The six patients, at least New York Heart Association （NYHA） Ⅱ, were male and their average age was （59 ± 12） years. The average period between onset and operation was （9 ±7） months. Six percutaneous left ventricular restoration operations were completed successfully with an average X-ray exposure time of （13. 6 ± 10. 4） minutes. No severe complication was observed, except one case suffered from postoperative hematoma on the left femoral artery. After 3 months of follow-up, the cardiac function was assessed as NYHA I in all cases 4 patients presented with complaints of foreign body sensation in the precordial region. Left ventricular ejection fraction increased from 0. 289 ± 0. 058 preoperatively to 0. 333 ±0. 034 postoperatively, diameter of end-diastole left ventricle decreased from （5.34 ± 0.67） mm to （5.31 ±. 0.62） mm and six-minute walking distance increased from （494.0± 103.9） m to （511.0± 72.9） m. Conclusion The Parachute system for percutaneous left ventricular restoration is safe and effective in clinical practice.