缺血性和非缺血性心肌病的外科治疗

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1、Non-transplantsurgicaltreatmentforischemicandnon-ischemiccardiomyopathyHayamaHeartCenterTadashiIsomura,JyojiHoshino,YasuhisaFukada,ShintaroKatahiraOperationforDCM(Dilatedcardiomyopathy)Surgicaltreatmentforischemicornon-ischemicdilatedcardiomyopathy(DCM)isachallengingtreatment.Leftventricularre

2、storation(LVR)orvalvesurgerywithotheraggressivetreatmentwasconductedandevaluated.Dyskinesis=LVaneurysmAkinesis=IschemicDCMDor.V;CurrentOpinioninCardiology1997,12:5341991.1235yM1999.643yMICM:LVRemodelingDCM,noMRPreopLVGNon-ischemicDCMCAG,LVG,BiopsyCardiacecho:ColorkinesisScintigramCine-MRISpec

3、kletrackingimageRadial,Circumferential,LongitudinalExaminationbeforeoperationRadialStrainSeptalLateralPosteriorNormalSeptalLateralPosteriorNormalHeartSpeckletrackingimage:CircumferentialstrainDCMNormalIschemic/Non-ischemic176/290Age57±9range29～83Male/Female379/87NYHAclassⅢ/Ⅳ257/209Elective/Eme

4、rgent380/86DCM(n=466)1997～2008.7OperativeproceduresforDCMLeftVentricularRestoration(LVR)EVCPP(Dor),SAVE,PLV(Batista)MitralValveSurgeryCABGCRT-D,Cryoablation………①EVCPP（Dor),②SAVE、③PLV(Batista)LVRIndicationforSAVEIndicationforPLVSAVE（SeptalanteriorVentricularExclusionwithlargepatch）EVCPP(Dor)98SA

5、VE(oroverlap)63(3)PLV(Batista)15CABG(n=143)2.7±1.3/patientMitral90(51％)MVR/MVP18/72Tricuspid29Cryoablation78（44％）IABP/LVAD27/3IschemicDCM(n=176)1997～2008.7SurgicalproceduresforNon-ischemicDCM-2006.5PLV(Batista)111（66％）－SAVE(orOverlap)57（3）－MVP/MVR84/74（94％）82/26（89％）TAP/TVR83/4（52％）78/5（68％）AV

6、R617Cryoablation6110PMplication32（19％）11（9％）CRT32（19％）21（17％）IABP/LVAD39/419/1WithLVR(n=168)WithoutLVR(n=122)IschemicDCM(n=176)Non-ischemicDCM(n=290)HospitaldeathElective6/150(4.0%)18/230(7.8%)Emergent8/26(31.0%)29/60(48.3%)LatefollowupNYHAclass1-2132148NYHAclass3-4920Latedeath20(CHF11,VT7,non

7、-cardiac2)75(CHF52,VT12,non-cardiac11)SurgicalresultsforDCM(N=466)PrognosisofCHFofStageCCirculation2007;115:1563-1570PrevalenceofCHFintheCommunity---AmmarKAetal.100.2234567Survivalrate0.40.60.81.0years0ABC1C2Circulation2007;115:1563-157