经皮左心室分隔术对心尖部室壁瘤形成的缺血性心力衰竭患者的安全性及疗效评估

Safety and Efficacy of Percutaneous Ventricular Partitioning in Ischemic Heart Failure Patients With Apical Aneurysm

目的:评价经皮左心室分隔术对心尖部室壁瘤形成的缺血性心力衰竭患者的安全性及疗效。方法:筛选心尖部室壁瘤形成的缺血性心力衰竭患者,通过临床及影像学评估后进行经皮左心室分隔术,评估手术的安全性并随访术后患者的临床事件及心功能指标。结果:共筛选19例心尖部室壁瘤形成的缺血性心力衰竭患者,平均年龄(68.1±8.2)岁,其中18例成功进行经皮左心室分隔术(95%),1例因装置无法达到最佳位置而终止手术。2例患者出现血管入路并发症置入股动脉支架。在术后(252±170)d的随访中,所有成功置入PARACHUTE的患者无器械衰败、心原性死亡、血栓栓塞或心力衰竭再住院。术后3个月患者的纽约心脏协会(NYHA)心功能分级较前明显改善(2.72±0.67 vs 1.67±0.59,P<0.01),6 min步行距离由术前(462±96)m增加至(484±87)m(P<0.01)。彩色超声心动图提示术后患者的左心室舒张末容积指数由([137.4±19.1)ml/m^2降至(125.6±18.5)ml/m^2,P=0.0056],左心室收缩末容积指数由([89.7±22.3)ml/m^2降至(78.8±20.7)ml/m^2,P=0.0019],左心室射血分数(LVEF)较术前明显提升[(34.8±8.1)%vs(41.3±6.2)%,P=0.031]。结论:初步的经验显示,使用Parachute行经皮左心室分隔术对严格筛选的心尖部室壁瘤形成的缺血性心力衰竭患者是安全、有效的;术后短期随访提示患者的血流动力学和功能性指标有所改善。

Objective： To evaluate the safety and efifcacy of percutaneous ventricular partitioning （PVP） in ischemic heart failure （IHF） patients with apical aneurysm. Methods： A total of 19 IHF patients with apical aneurysm at the age of （68.1 ± 8.2） years were enrolled. The patients received PVP operation with adequate clinical and medical imaging examinations; the safety of operation was evaluated and post-operative clinical events with cardiac function were followed-up. Results： There were 18/19 （95%） patients with successful PVP and 1 had to stop the operation due to unsatisfactory landing of ventricular partitioning device. 2 patients suffered from vessel access related complication and received femoral artery stent implantation. With （252 ± 170） days follow-up study, no post-operative device failure, cardiac death, thromboembolism and HF re-hospitalization occurred. At 3 months after operation, the patients had improved NYHA classiifcation （2.72 ± 0.67） vs （1.67 ± 0.59） and 6 min walk test （462 ± 96） m vs （484 ± 87） m, bothP〈0.01. Echocardiography indicated that post-operative left ventricle end-diastolic volume index （LVEDVI） decreased form （137.4 ± 19.1） ml/m2 to （125.6 ± 18.5） ml/m2,P=0.0056 and LVESVI decreased from （89.7 ± 22.3） ml/m2 to （78.8 ± 20.7） ml/m2,P=0.0019; while LVEF increased from （34.8 ± 8.13） % to （41.3 ± 6.2） %,P=0.031. Conclusion： Our preliminary experience showed that with adequate evaluation, PVP was safe and effective in IHF patients with apical aneurysm; short-term follow-up study implied the improved hemodynamic and cardiac function.