Objective To compare the clinic results between offpump left ventricular(LV) aneurysm plication repair and onpump LV linear aneurysmectomy for LV dyskinetic aneurysm (DA), and to improve the curative effect of aneurysm. [WTHZ]Methods From September 2003 to September 2007, 32 patients with DA located in the anterior wall or apex of LV were operated. There were 23 male and 9 female aged 4670 years with a mean age of 63 years. According to the procedure with or without cardiopulmonary bypass(CPB), 32 patients were divided into two groups: Offpump group (n=17), with the size of DA represented 25%-37% of left cavity. Patients in this group underwent offpump LV aneurysm plication repair; Onpump group (n=15), with the size of DA represented 27%-40% of left cavity. Patients in this group underwent onpump LV linear aneurysmectomy. Coronary artery bypass grafting was the concomitant procedure in both groups. The clinic results were compared and evaluated via indexes such as left ventricular volume, systolic function etc which were determined by echocardiography. [WTHZ]Results No operation death was found in both groups. In offpump group, there was no perioperative complication. Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.8 grade vs. 2.9±0.3 grade，P=0.001), left ventricular ejection fraction（LVEF） improved significantly (41.0%±4.5% vs. 36.4%±4.8%，P=0.035), and left ventricular [CM(159mm]endsystolic volume index (LVESVI) reduced significantly (52.6±27.7 ml/m2 vs. 79.7±21.4 ml/m2, P=0.003) compared with that before operation. Seventeen cases were followed up, and the followup time was 12-53 months with a mean time of 29 months. No death was found during following up. One case was reoperated 1 year after operation because of severe mitral valve regurgitation. One case had congestive heart failure 3 years after operation with a LVEF of 31% and still in observation. The other cases were fine. In onpump group, there were 3 cases had perioperative complications (Two with neurological complications and one with respiratory failure). Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.6 grade vs. 3.1±0.9 grade，P=0.001). LVEF improved significantly (42.3%±3.2% vs. 35.6%±6.5%, P=0.023). LVESVI reduced obviously (49.3±22.6 ml/m2 vs. 81.3±25.0 ml/m2, P=0.003) compared with that before operation. Fifteen cases were followed up and the followup time was 1260 months with a mean time of 35 months. No death was found during following up and the clinic results were good. No significant difference was observed between the two groups (Pgt;0.05). [WTHZ]Conclusion Offpump LV aneurysm plication repair for LV dyskinetic aneurysm can effectively reduce the volume of LV, improve LVEF and cause less perioperative complications. It is a safe and effective procedure. Its longterm prognosis needs further observation.
ObjectiveTo evaluate early and midterm outcomes of aortic root enlargement (ARE) combined with supra-annular valve implantation for adult patients with aortic stenosis (AS) and small aortic roots (SARs). MethodsFrom January 2007 to July 2011, ARE combined with supra-annular valve implantation was performed for 38 adult patients with AS and SARs in Department of Cardiac Surgery of Beijing Anzhen Hospital. There were 12 males and 26 females with their age of 16-58 (38.6±21.0) years, body weight of 48-78 (58.5±12.0) kg, body height of 153-176 (162.8±12.0) cm and a mean body surface area (BSA) of 1.67±0.32 m2. There were 19 patients with rheumatic AS, 11 patients with congenital bicuspid aortic valve and AS, 5 patients with degenerative AS and 3 patients with AS and infective endocarditis. Preopera-tively, 8 patients were in NYHA class Ⅱ, 29 patients were in NYHA class Ⅲ, and 1 patient was in NYHA class Ⅳ. Aortic annular diameter (AAD) was 15-20 (17.6±2.8) mm and trans-aortic pressure gradient was 53-75 (62.8±10.5) mm Hg. ResultsCardiopulmonary bypass time was 83-145 (112±29) minutes, and aortic cross-clamping time was 58-116 (87±28) minutes. Intraoperative measurement of AAD was 15-20 (17.3±2.6) mm, AAD after ARE was 20-25 (22.6±2.3) mm. AAD after ARE was 12-17 (14.0±2.6) mm larger than AAD before ARE. Actual size of prosthetic valves was 2-3 sizes larger than predicted size without ARE in all the patients. There was no perioperative death or severe complication including bleeding. Length of ICU stay was 12-41 (26±14) hours, and length of hospital stay was 9-15 (12.5±3.2) days. A total of 37 patients (97.4%) were followed up for over 2 years after discharge. All the patients were in NYHA class Ⅰ. Grade 2/6 systolic murmur was heard in 3 patients. Electrocardiogram (ECG) showed significant improvement or complete disappearance of left ventricular hypertrophy in 35 patients, and mild left ventricular hypertrophy in 2 patients. ECG during follow-up didn't show any sign of myocardial ischemia, ventricular arrhythmia or severe atrioventricular block in any patient. ConclusionEarly and midterm outcomes of ARE combined with supra-annular valve implantation for adult patients with AS and SARs are satisfactory, but long-term outcomes of this procedure need further follow-up.