联合冠状动脉旁路移植术和其他心脏手术

Combined coronary artery bypass grafting and other heart surgical procedures——Clinical Analysis of Consecutive 134 cases

目的 回顾分析联合冠状动脉旁路移植术和其他心脏手术的临床效果。方法 134例患者中 ,75 .4 %例有Ⅲ～Ⅳ级心绞痛 (CCSS) ,5 1.2 %有个至少 1次心肌梗死史。冠状动脉造影示梗阻性病变在左主干 (LM) 34例次、左前降支 (LAD) 130例次、对角支 91例次、回旋支 84例次、右冠状动脉 80例次。伴有冠状动脉弥漫性病变 4 1例。左室射血分数 (LVEF) 18%～ 6 9% ,4 5 %～ 30 % 5 0例 ,<30 % 13例 ;伴左心室壁瘤 5 6例 ,同时伴瓣膜功能不全 4 2例。全部患者均在体外循环下行冠状动脉旁路移植术 ,对 36例伴有冠状动脉弥漫性病变者同期激光心肌打孔 (TMLR) ,同期左心室壁瘤切除三明治式缝合11例 ,巨大室壁瘤心内补片左室成形 4 5例 ;同期心脏瓣膜手术 4 2例 (其中 4例患者同时心脏室壁瘤切除心内补片成型 )。结果 人均旁路 2 .4 6支 ,6例患者需IABP辅助 11～ 5 4h ;2次开胸止血 6例 ;并发室上速和房颤 2 8例 ,室性心律失常 10例 ,2例电转复 ,余均药物控制 ;全组手术死亡 3例 ,死亡原因分别为严重低心排综合征 (2例 )和多脏器功能衰竭。 131例患者手术后心绞痛等症状均缓解 ,心脏功能明显改善。随访 4～ 6 0个月 (平均 12 .7个月 ) ,随访率 89% ,6 5例已恢复全日工作。结论 与单纯冠状动脉旁路多植术相比 。

Objective To retrospectively review clinical results of combined coronary artery bypass grafting (CABG) and other heart surgical procedures.Methods Combined CABG and other heart surgical procedures have been done in 134 consecutive cases (male 114, female 20), aged from 48 to 76 years with a mean of 61.7. Coronary angiograph showed that all patients have coronary stenosis with left main involved in 20 cases, and 41 cases have diffused coronary artery disease. 56 patients have post myocardial infarction left ventrical aneurysms, and 42 patients have valve dysfunction which need surgical correction. Left ventricular ejection fraction (EF) were equal to or lower than 45% in 63 patients and in 13 patients EF is less than 30%. All the patients received combined CABG under the support of cardiopulmonary bypass (CPB) and other heart surgical procedures (Transmyocardial laser revascularization in 36, valve procedures in 42, and left ventricle aneurysm resection or plasty in 56 patients simultaneously). Results The mean number of grafts was 2.46 per patient. Intra-aortic balloon pump was required in 6 cases for 11 to 54 hours Postoperative. 3 patients died postoperatively with mortality rate 2.2% (two from low cardiac output syndrome, and one from multiple organs failure). 131 patients recovered and discharged.Conclusion Combined CABG and other heart surgical procedures in more demanding than CABG along but can be done with acceptable morbidity and mortality if good surgical plan can be designed and all the heart abnormalities can be corrected simultaneously.