封堵伞联合外科补片治疗心肌梗死后室间隔穿孔的疗效分析

Clinical results of surgical repair combining an occluder and a patch for ventricular septal rupture after myocardial infarction

目的探讨封堵伞联合外科补片治疗心肌梗死后室间隔穿孔手术效果及患者预后。方法回顾性分析2010年1月—2021年9月郑州大学第一附属医院心脏大血管外科收治的心肌梗死合并室间隔穿孔42例患者的临床资料。根据外科手术方式将其分为:传统组27例,采用单纯心包片修补穿孔,其中男17例、女10例,平均年龄(62.81±6.81)岁;改良组15例,采用封堵伞联合外科补片修补穿孔,其中男11例、女4例,平均年龄(64.27±9.24)岁。对比分析两组患者围手术期及随访资料。结果两组患者术前Killip分级、主动脉内球囊反搏使用率、心肌梗死至手术的间隔时间、“罪犯”血管数量差异有统计学意义(P<0.05)。其余术前资料差异无统计学意义(P>0.05)。两组患者术中体外循环时间、主动脉阻断时间、术后住院时间和住院死亡率差异无统计学意义(P>0.05)。改良组术后未发生残余分流,与传统组相比差异有统计学意义(P=0.038)。两组其余并发症差异无统计学意义(P>0.05)。中位随访时间4年,传统组随访期间死亡2例,改良组死亡1例。两组患者随访心功能分级差异有统计学意义(P=0.023)。结论心肌梗死后室间隔穿孔的外科治疗围手术期死亡率高,但远期疗效满意。封堵伞联合外科补片治疗室间隔穿孔可有效减少术后残余分流,是一种安全、有效的治疗方式。

Objective To investigate the effect and prognosis of patients with ventricular septal rupture after myocardial infarction treated by surgical repair combining an occluder and a patch.Methods Clinical data of 42patients with myocardial infarction complicated with ventricular septal rupture admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2021 were retrospectively analyzed.According to the surgical methods,27 patients were divided into a traditional group,including 17 males and 10 females,with an average age of62.81±6.81 years,who were repaired by patch only,and 15 patients were divided into a modified group,including 11males and 4 females,with an average age of 64.27±9.24 years,who were repaired by surgery combining an occluder and a patch.Perioperative and follow-up data of the two groups were compared and analyzed.Results There were statistical differences between the two groups in preoperative Killip grading,rate of intra-aortic balloon pump use,interval from myocardial infarction to operation,and the number of culprit artery(P<0.05).There was no statistical difference in other preoperative data,the cardiopulmonary bypass time,aortic cross-clamping time,postoperative hospital stay or in-hospital death rate between the two groups(P>0.05).No residual shunt occurred in the modified group,and the difference was statistically significant compared with the traditional group(P=0.038).There was no statistical difference in other complications between the two groups(P>0.05).The median follow-up time was 4 years.Two patients in the traditional group and one in the modified group died during follow-up.The follow-up cardiac function grading of patients in the modified group was statistically different from that in the traditional group(P=0.023).Conclusion The perioperative mortality of ventricular septal rupture after myocardial infarction is high,but the long-term effect is satisfactory.Surgical repair combining an occluder and a patch is a safe and effective treatment for ventricular septal rupture,which can effectively reduce postoperative residual shunt.