全动脉化冠状动脉旁路移植术在左心功能不全患者中的应用

Total arterial revascularization in left ventricular dysfunction

目的：评估2根动脉桥血管全动脉化冠状动脉（冠脉）旁路移植术在左心功能不全患者中应用的可行性和安全性。方法：前瞻性收集1994年11月～2002年8月用2根动脉桥血管进行全动脉化冠脉旁路移植术的179例左室射血分数（LVEF）〈50％（正常≥70％）的冠脉多支病变临床病例进行研究。其中急性冠脉综合征3例，不稳定型心绞痛43例；LVEF〈30％29例；2次手术14例，3次手术3例。82％的患者应用含有左侧乳内动脉的Y型桥（其中右乳内动脉40．8％，桡动脉33．5％，其他7．8％）。结果：左心功能不全组围术期死亡率2．2％，心肌梗死1．7％，脑血管意外0．6％，胸骨感染3．3％，呼吸衰竭7．8％，与左心功能正常组相比较差异无统计学意义。结论：左心功能不全患者可以安全地用2根动脉桥血管进行全动脉化冠脉旁路移植术。桡动脉长于右乳内动脉，即使左心功能不全（左室扩大）的情况下也足以完成全动脉化冠脉旁路移植术。

Objective：Left ventricular dysfunction increases the risks of coronary artery surgery and has particular implications in total arterial revascularization . This study evaluated the feasibility and safety of total arterial coronary revascularization with two arterial conduits in patients with impaired left ventrieular function. Method： Data were prospectively collected on 179 patients with multiple vessel disease and an ejection fraction of less than 0.50 （normal≥0.70）, who underwent coronary surgery with the intention of total arterial revascularization with 2 conduits between September 1994 and August 2002. Acute coronary insufficiency was present in 3 patients and 43 had unstable angina. The left ventrieular ejection fraction was less than 0.30 in 29 patients. There were 17 redo operations including 3 redo-redo procedures. Eighty-two percent had a Y graft configuration from the left internal mammary artery （right internal mammary artery 40.8%, radial artery 33.5%, other 7.8%）. Result： There were no statistical significant differences between the two groups regarding perioperative mortality （2.2 %） and morbidities including myocardial infarction 1.7 %, stroke 0.6 %, sternal infection 3.3 % ,and respiratory failure 7.8 %. Conclusion;It is concluded that total arterial revaseularization in patients with ischaemic left ventricular dysfunction can be safely performed with 2 arterial conduits. The radial artery provides conduit length greater than the right internal mammary artery and allows full revascularization despite left ventricular dilatation.