同期心脏瓣膜手术与冠状动脉旁路移植术81例

Combined Cardiac Valve Surgery and Coronary Artery Bypass Grafting:Report of 81 Cases

目的总结同期施行心脏瓣膜手术和冠状动脉旁路移植术（CABG）的效果和临床经验。方法2000年1月至2005年12月我科同期施行心脏瓣膜手术／cABG81例。风湿性心脏瓣膜疾病合并冠状动脉病变37例，冠心病合并心脏瓣膜功能不全44例。冠状动脉造影显示：单支血管病变18例，双支血管病变9例，多支血管病变54例。同期施行心瓣膜置换术和CABG55例，瓣膜成形术和CABG26例，其中同期行室壁瘤手术4例。人均冠状动脉远端吻合3．12±1．51个。术后发生低心排血量4例，需主动脉内球囊反搏支持。结果2例因手术后发生低心排血量和多器官功能衰竭死亡。再次开胸止血3例。79例患者取得了良好的临床效果，心脏功能明显改善。手术后随访64例，失访15例，随访时间1～74个月，平均随访14．2个月，随访期间死亡5例，均为非心源性死亡。其余患者生活质量明显改善。结论同期施行心脏瓣膜手术／CABG是有效可行的，近期效果满意。

Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting （CABG）. Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.