终末期心肌病的左成形术

LEFT VENTRICULOPLASTY FOR ENDSTAGE CARDIOMYOPATHY HISAYOSHI SUMA THE CARDIOVASCULAR INSTITUTE TOKYO LEFT VENTRICULOPLASTY lSCHEMIC CARDIOMYOPATHY -EVCPP(Dor) , SAVE(Suma) NON ISCHEMIC CARDIOMYOPATHY -PLV(Batista) , SAVE(Suma) ISCHEMIC CARDIOMYOPATHY Definition: Non-aneurysmal diffuse akinetic left ventricle with chronic heart failure following myocardial infarction Diastole Systole (EF 6%) ISCHEMIC CARDIOMYOPATHY Trias of “ Bad ” ventricle Dilated LV Intractable heart failure No angina pectoris 024681012 1.0 0.8 0.6 0.2 0.0 Years since operation n = 57 EF 2 + (n=56) = - HAYAMA HEART CENTER - VENTRICULOPLASTY FOR IDIOPATHIC DCM - Actuarial Survival Curve - 100 90 80 70 60 50 40 10 0 30 20 1234567 Survival Rate (%) Postoperative Years 66.4 53.5 44.7 41.3 n = 96 VENTRICULOPASTY FOR DCM 0 12345 100 (%) Survival Rate Postoperative Years 50 LVP No inotropes LVP Preop. inotropes LVAS REMATCH Medical Treatment 55 60 78 20 10 43 74 34 59 LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (%) 40 30 20 10 0 Preop.Preop. 1 mo.1 yr2 yrs3 yrs n 80 74 28 20 9 19.8 30.1 31.8 30.2 28.3 (mmHg) 30 20 10 0 Preop.Preop. 1 mo.1 yr2 yrs3 yrs n 37 31 19 6 26 2222 18 EF LVEDP LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (l/min/m2) (pg/ml) 1000 500 0 Preop.Preop. 1 mo.1 yr2 yrs3 yrs 898 629 413 229 4 3 2 1 0 Preop.Preop. 1 mo.1 yr2 yrs3 yrs n 35 33 23 18 6 2.3 3.3 2.82.8 2.7 362 CI BNP n 41