终末期心肌病的左成形术.ppt

LEFTVENTRICULOPLASTYFORENDSTAGECARDIOMYOPATHY,HISAYOSHISUMA,THECARDIOVASCULARINSTITUTETOKYO,LEFTVENTRICULOPLASTY,ISCHEMICCARDIOMYOPATHY,Definition:,Non-aneurysmaldiffuseakineticleftventriclewithchronicheartfailurefollowingmyocardialinfarction,Diastole,Systole(EF6%),ISCHEMICCARDIOMYOPATHYTriasof“Bad”ventricle,DilatedLVIntractableheartfailureNoanginapectoris,0,2,4,6,8,10,12,1.0,0.8,0.6,0.2,0.0,Yearssinceoperation,n=57,EF35%,CABGFORISCHEMICCARDIOMYOPATHY,Shahet.al.JTCVS2OO3;126:1320-7,0.4,EstimateofSurvival,50%,20%,SAVEoperation,SAVEFORDCM,Preop.,Postop.,EF(%)EDVI(ml/m2)ESVI(ml/m2)BNP(pg/ml),27233171714,39133,81267,SAVEFORDCM,Preop.,Postop.,LVEDP(mmHg)PAP(mmHg),1128/17,1838/15,LEFTVENTRICULOPLASTYFORISCHEMICCARDIOMYOPATHY,-HAYAMAHEARTCENTER-,VENTRICULOPLASTYFORIDIOPATHICDCM-ActuarialSurvivalCurve-,100,90,80,70,60,50,40,10,0,30,20,1,2,3,4,5,6,7,SurvivalRate,(%),PostoperativeYears,66.4,53.5,44.7,41.3,n=96,VENTRICULOPASTYFORDCM,0,1,2,3,4,5,100,(%),SurvivalRate,PostoperativeYears,50,LVPNoinotropes,LVPPreop.inotropes,LVASREMATCH,MedicalTreatment,55,60,78,20,10,43,74,34,59,LEFTVENTRICULOPLASTYFORIDIOPATHICDCM,(%),40,30,20,10,0,Preop.,Preop.1mo.,1yr,2yrs,3yrs,n807428209,19.8,30.1,31.8,30.2,28.3,(mmHg),30,20,10,0,Preop.,Preop.1mo.,1yr,2yrs,3yrs,n3731196,26,22,22,18,EF,LVEDP,LEFTVENTRICULOPLASTYFORIDIOPATHICDCM,(l/min/m2),(pg/ml),1000,500,0,Preop.,Preop.1mo.,1yr,2yrs,3yrs,898,629,413,229,4,3,2,1,0,Preop.,Preop.1mo.,1yr,2yrs,3yrs,n353323186,2.3,3.3,2.8,2.8,2.7,362,CI,BN