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題名 | Left Ventricular Aneurysm Repair: A Comparison of Linear Versus Patch Remodeling=左心室瘤修補:線型修補術與貼片型修補術之比較 |
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作者 | 陳威元; 吳飛逸; 施俊哲; 賴曉亭; 許喬博; Chen, Wei-yuan; Wu, Fei-yi; Shih, Chun-che; Lai, Shiau-ting; Hsu, Chiao-po; |
期刊 | Journal of the Chinese Medical Association |
出版日期 | 20090800 |
卷期 | 72:8 2009.08[民98.08] |
頁次 | 頁414-421+CA77 |
分類號 | 416.26 |
語文 | eng |
關鍵詞 | 運動障礙型瘤; 左心室瘤; 線型修補術; 貼片型修補術; 心肌梗塞後; Dyskinetic aneurysm; Left ventricular aneurysm; Linear repair; Patch repair; Postinfarction; |
英文摘要 | BACKGROOUND : Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms. METHODS : We retrospectively reviewed the records of 49 patients (mean age, 69.8 ± 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. RESULTS : Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 ± 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7%, 69.9% and 45.7%, respectively. Functional class improved from 2.51 ± 0.59 to 1.66 ± 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class ≥ 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 ± 7.2% to 34.1 ± 7.9% (p < 0.001) in the patch group, and from 26.3 ± 9.0% to 32.0 ± 9.2% in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 ± 10.1% to 52.0 ± 7.3% (p = 0.190) in the patch group, but deteriorated from 55.0 ± 6.3% to 50.3 ± 8.6% in the linear group (p = 0.029). CONCLUSION : These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus. |
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