终末期心肌病左成形术.pptVIP

* 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 0 2 4 6 8 10 12 1.0 0.8 0.6 0.2 0.0 Years since operation n = 57 EF 35% CABG FOR ISCHEMIC CARDIOMYOPATHY Shah et.al. JTCVS 2OO3; 126:1320 - 7 0.4 Estimate of Survival 50% 20% SAVE operation Septal Anterior Ventricular Exclusion SAVE FOR　DCM Preop. Postop. EF (%) EDVI (ml /m2 ) ESVI (ml /m2) BNP (pg/ml) 27 233 171 714 EF (%) EDVI (ml /m2 ) ESVI (ml /m2) BNP (pg/ml) 27 233 171 714 39 133 81 267 SAVE FOR　DCM Preop. Postop. LVEDP(mmHg) PAP (mmHg) 11 28/17 18 38/15 LEFT VENTRICULOPLASTYFOR ISCHEMIC CARDIOMYOPATHY 100 (%) 50 1 2 3 4 5 Survival Rate Postoperative years 91 82 67 75 64 64 No MR (n=68) MR 2 + (n=56) = - HAYAMA HEART CENTER - *