Left Ventricular Reconstruction Surgery in Candidates for Heart Transplantation

Abstract Objective: To report our center’s experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival. Methods: Observational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival. Results: Overall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P≤0.01; hazard ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS mortality/morbidity score mean value was 18.14, P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical techniques showed no difference in survival among Dor 81% vs. Jatene 91.7%. Conclusion: Surgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.

摘要
研究目的：总结本中心在心室重构外科治疗领域的临床经验。该技术安全高效，可使缺血性病因所致终末期心力衰竭患者获得临床症状改善并延长生存周期。
研究方法：本研究为观察性、临床外科性、连续性回顾性研究。研究对象为2010年1月至2016年12月期间，在丹特·帕扎内塞心脏病学研究所心力衰竭、心室功能障碍与心脏移植门诊就诊的缺血性心肌病合并左心室动脉瘤患者。共收集34例患者的临床资料，包括系统性高血压、左心室射血分数、纽约心脏协会（New York Heart Association, NYHA）功能分级、欧洲心脏手术风险评估系统Ⅱ（European System for Cardiac Operative Risk Evaluation Ⅱ, EuroSCORE Ⅱ）评分、胸外科医师学会（Society of Thoracic Surgeons, STS）评分、心室重构手术方式及生存结局。
研究结果：总体死亡率为14.7%，其中住院期间死亡率为8.82%，晚期死亡率为5.88%。患者5年总生存率达85.3%。术前纽约心脏协会功能分级分布为：Ⅰ级5例、Ⅱ级18例、Ⅲ级8例、Ⅳ级3例；术后该分级分布为：Ⅰ级17例、Ⅱ级8例、Ⅲ级6例、Ⅳ级3例。EuroSCORE Ⅱ平均评分为6.29，P≤0.01；风险比（HR）为1.16（95%置信区间[CI] 1.02~1.31）。STS死亡率与并发症平均评分为18.14，P≤0.004；风险比为1.19（95%置信区间[CI] 1.05~1.33）。不同手术方式的生存率无显著差异：Dor术式组为81%，Jatene术式组为91.7%。
研究结论：针对心脏移植候选患者的左心室重构外科治疗安全、高效且有效，可获得良好的长期生存预后。