一站式杂交技术治疗成人复杂性心脏病

One-stop hybrid cardiac surgery for adults with complex heart disease

目的评价一站式杂交技术治疗成人复杂性心脏病的疗效及安全性。方法2011年11月至2012年3月，入选5例成人复杂性心脏病患者接受一站式杂交手术治疗。其中，男性4例，女性1例；年龄（58．8±14．7）岁；冠状动脉多支病变2例，冠心病合并瓣膜病2例，动脉导管未闭合并瓣膜病1例。手术在一站式杂交手术室进行，经胸部肋间小切口施行微创心脏手术（左前降支冠状动脉旁路移植术或瓣膜手术），并同期行介入治疗。术后分析其疗效及安全性。结果5例患者均顺利行一站式杂交手术，即刻冠状动脉造影显示左乳内动脉桥均通畅。共有6处非左前降支病变接受经皮冠状动脉介入治疗（置入药物洗脱支架6枚）。围手术期未发生死亡、心肌梗死、心力衰竭、瓣膜相关并发症、呼吸衰竭、卒中和二次手术。平均随访3．2（1～5）个月，所有患者均存活，无心绞痛、人工瓣膜障碍及动脉导管再通病例。结论一站式杂交技术治疗成人复杂性心脏病能减少手术创伤，降低手术复杂性，且安全、有效。

Objective To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of adult patients with complex heart disease. Methods From November 2011 to March 2012, a total of 5 patients [4 male, mean age： （58.8 ±14.7 ）years ] underwent one-stop hybrid approach in the hybrid operating room. Two patients suffered from multi-coronary lesions, 2 patients were diagnosed with both valvular heart disease and coronary disease, and another 1 patient had valve disease and congenital heart disease （patent ductus arteriosus）. Minimally invasive cardiac surgery（ coronary artery bypass grafting for the left anterior descending or valvular surgery） and percutaneous intervention were performed in an enhanced operative unit. The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure. Results The one-stop hybrid procedure was successful in all patients. Left internal mammary artery grafts were unobstructed. A total of 6 non-left anterior descending coronary lesions were treated by percutaneous coronary intervention and 6 drug-eluting stents were implanted. There was no death, perioperative myocardial infarction, heart failure, prosthetic valve dysfunction, respiratory failure, stroke or repeat surgery during the procedure period. All patients remained free from angina, prosthetic valve dysfunction and patent ductus arteriosus recanalisation during the 3.2 months （rang 1 to 5 months） follow-up period. Conclusion One-stop hybrid cardiac surgery provides a reasonable, feasible and safe alternative for treating adult patients with complex heart disease.