■冠状动脉疾病引起的射血分数降低(HFrEF)的缺血性心力衰竭占预后最差的心力衰竭病例的最大比例。冠状动脉旁路移植术(CABG)是缺血性HFrEF最有效的治疗方法。泵上和泵外是用于CABG的两种手术方法。在冠心病手术中,HFrEF患者是否应该进行体外循环或非体外循环CABG是有争议的。左心室收缩末期容积指数(LVSEVI)是评价左心室重构严重程度的金标准;其对HFrEF行CABG患者围手术期风险和长期生存率的影响尚不清楚.
■这项单中心前瞻性队列分析包括118例冠心病患者,这些患者的症状和体征为心力衰竭,左心室射血分数(LVEF)<40%,从2019年1月至2023年12月连续入选。手术死亡率,围手术期并发症,比较了接受各种LVESVIs和手术方法治疗的患者的长期生存率。主要结果是心脏死亡,心肌梗塞,心力衰竭,中风,和血运重建,(经皮冠状动脉介入治疗或重做CABG),中位随访时间为38±10个月。
■118例患者术后30天死亡率为6.8%。非体外循环组患者的围手术期死亡率明显高于体外循环组(12.5%vs.3.8%,p=0.03)。在离泵组中,需要围手术期机械辅助的患者比例较高,如主动脉内动脉球囊泵(IABP)或体外膜氧合(ECMO),与上泵组相比(IABP:75%与47.4%,p=0.004;ECMO:22.5%vs.1.3%,p=0.000)。非体外循环组患者更有可能发生术后心房颤动(AF)(35%vs.14.1%,p=0.01)。在泵上组中,术后房颤的发生率(25%vs.6.5%,p=0.02)和IABP使用率(62.5%与36.9%,p=0.03)在左心室重塑较严重的患者中明显高于左心室重塑较不严重的患者。在离泵组中,左心室重塑更严重的患者ECMO使用率更高(38.9%vs.9.1%,p=0.04),术后房颤发生率(61.1%vs.13.6%,p=0.02),围手术期死亡率(22.2%)。停泵组无主要不良心脏事件(MACE)生存率明显高于停泵组,不同左心室重塑程度的两组患者无MACE生存率差异无统计学意义。
■对于缺血性HFrEF患者,泵上旁路是一种更好的手术方法,尤其是左心室严重重塑的患者.左心室重塑会增加围手术期死亡率,但对长期生存率没有影响。
UNASSIGNED: Ischaemic heart failure with reduced ejection fraction (HFrEF) caused by coronary artery disease accounts for the largest proportion of heart failure cases with the worst prognosis. Coronary artery bypass grafting (CABG) is the most effective treatment for ischaemic HFrEF. On-pump and off-pump are the two surgical methods used for CABG. Whether patients with HFrEF should undergo on- or off-pump CABG is controversial in coronary heart disease surgery. The left ventricular end-systolic volume index (LVSEVI) is the gold standard for evaluating the severity of left ventricular remodelling; however, its effect on the perioperative risk and long-term survival rate of patients with HFrEF undergoing CABG remains unclear.
UNASSIGNED: This single centre prospective cohort analysis included 118 coronary heart disease patients with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF) of <40% who were enrolled consecutively from January 2019 to December 2023. Operative mortality, perioperative complications, and long-term survival were compared among patients treated with various LVESVIs and surgical methods. The primary outcomes were cardiac death, myocardial infarction, heart failure, stroke, and revascularization, (percutaneous coronary intervention or redo CABG) with a median follow-up of 38 ± 10 months.
UNASSIGNED: The 30-day postoperative mortality of 118 patients was 6.8%. Patients in the off-pump group had significantly higher perioperative mortality than those in the on-pump group (12.5% vs. 3.8%, p = 0.03). In the off-pump group, a higher proportion of patients required perioperative mechanical assistance, such as intra-aortic artery balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO), compared to those in the on-pump group (IABP: 75% vs. 47.4%, p = 0.004; ECMO: 22.5% vs. 1.3%, p = 0.000). Patients in the off-pump group were more likely to have postoperative atrial fibrillation (AF) (35% vs. 14.1%, p = 0.01). In the on-pump group, the incidence of postoperative AF (25% vs. 6.5%, p = 0.02) and IABP use (62.5% vs. 36.9%, p = 0.03) were significantly higher in patients with more severe left ventricular remodelling than in those with less severe left ventricular remodelling. In the off-pump group, patients with more severe left ventricular remodelling had higher ECMO usage (38.9% vs. 9.1%, p = 0.04), incidence of postoperative AF (61.1% vs. 13.6%, p = 0.02), and perioperative mortality (22.2%). Major adverse cardiac event (MACE)-free survival rate was significantly higher in the on-pump group than in the off-pump group, and there was no significant difference in MACE free survival rates between the two groups of patients with different degrees of left ventricular remodelling.
UNASSIGNED: On-pump bypass is a better surgical procedure for patients with ischaemic HFrEF, especially those with severe left ventricular remodelling. Left ventricular remodelling increases perioperative mortality but has no effect on long-term survival.