心外膜左心室重建术对前间壁瘢痕形成的缺血性心力衰竭患者的短期安全性及疗效评价

The safety and effi cacy of epicardial ventricular restoration in patients with antero-septal scar and dilated ischemic cardiomyopathy

目的初步评价使用Revivent系统进行心外膜左心室重建术,在前间壁瘢痕形成的缺血性心力衰竭患者中的安全性及有效性。方法 2017年2月起,厦门大学附属心血管病医院使用Revivent系统完成10例前间壁瘢痕形成的缺血性心力衰竭患者的心外膜左心室重建术。本文使用磁共振分析这10例手术的短期临床效果并对初步的操作经验作一总结。结果入选10例前间壁瘢痕形成的缺血性心力衰竭患者,其中9例男性,1例女性。年龄(55.2±13.9)岁。患者均成功完成手术,顺利出院。术后1个月患者的NYHA分级由(2.9±0.6)改善至(1.5±0.5)(P<0.01),左心室射血分数由(27.8±8.4)%提升至(37.5±11.4)%(增加35.0%,P<0.01),左心室收缩末期容积由(149.9±61.6)ml降至(109.9±58.0)ml(降低26.7%,P<0.01),收缩末期容积指数由(84.8±36.7)ml/m2降至(63.0±34.2)ml/m2(降低25.7%,P<0.01);左心室舒张末期容积由(203.0±64.0)ml降至(167.9±58.2)ml(降低17.3%,P<0.01),舒张末期容积指数由(114.5±37.8)ml/m2降至(96.2±35.2)ml/m2(降低16.0%,P<0.01)。心输出量由(4.0±1.5)L/min增加至(4.8±1.2)L/min(增加20.0%,P=0.034),心脏指数由(2.2±0.7)L/(min?m2)增加至(2.7±0.7)L/(min?m2)(增加22.4%,P=0.023)。结论使用Revivent系统行心肌梗死后心外膜左心室重建术能够明显减少左心室舒张末期和收缩末期容积/容积指数,提高左心室射血分数和心输出量/心脏指数,改善患者的心力衰竭症状,对前间壁广泛瘢痕形成的缺血性心力衰竭患者的安全性和有效性有待大样本、长期的研究进一步证实。

Objective To evaluate the safety and efficacy of epicardial ventricular restoration（EVR） using REVIVENT system in patients with antero-septal scar and dilated ischemic cardiomyopathy. Methods Ten ischemic heart patients with antero-septal scar underwent the operation. The scarred lateral lef t ventricular wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural excluding the non-viable portions of the chamber. Left ventricular hemodynamic assessments as well as left ventricular ejection fraction, left ventricular end-systolic/diastolic volume（LVEDV/LVESV） and their indexes（LVEDVI/LVESVI） were measured by cardiac magnetic resonance（CMR）. Results Ten ischemic heart failure patients with antero-septal scar, aged（55.2±13.9）years, received a hybrid epicardial ventricular restoration. Cardiac MR done at one a month after the procedure showed an elevation of LVEF f rom（27.8±4.6%）to（37.5±11.4）%（＋35%, P〈0.01）. LVESV was significantly reduced f rom（149.9±61.6）ml to（109.9±58.0）ml（–26.7%, P〈0.01）, LVESVI was reduced f rom（84.8±36.7）ml/m^2 to（63.0±34.2）ml/m^2（reduced by 25.7%, P〈0.01）; LVEDV was reduced from（203.0±64.0）ml to（167.9±58.2）ml（reduced by 17.3%, P〈0.01）, and LVESV was reduced f rom（114.5±37.8）ml/m^2 to（96.2±35.2）ml/m^2（reduced by 16.0%, P〈0.01）. Cardiac output（CO） increased f rom（4.0±1.5）L/min to（4.8±1.2）L/min（increased by 20.0%, P=0.034） and cardiac index（CI） increased from（2.2±0.7）L/（min · m^2） to（2.7±0.7）L/（min · m^2）（increased by 22.4%, P=0.023）. Conclusions Our preliminary experience on EVR using the REVIVENT system demonstrated signifi cant increase in LVEF, CO and CI, with decreases in LVEDV/LVESV at 1 month following the procedure. Its feasibility and safety need further evaluation in the future.