分站式杂交冠状动脉血运重建术治疗多支血管病变的经验

Clinical experience of stage Ⅱ hybrid procedure for performing multivessel coronary artery revascularization

目的总结经左胸部小切口冠状动脉旁路移植术(MIDCAB)与经皮冠状动脉介入(PCI)治疗相结合的分站式杂交手术(Hybrid)治疗复杂冠状动脉多支血管病变的临床经验。方法 2011年1月至2014年10月,郑州市第七人民医院共26例包括冠状动脉前降支病变在内的多支血管病变患者接受分站式杂交手术治疗,其中男17例,女9例,年龄(54.3±8.5)岁。研究终点为无主要心脑血管不良事件生存率。结果本组患者均顺利实施分站式冠状动脉血运重建,全部行左侧内乳动脉至前降支冠状动脉旁路移植术,置入药物洗脱支架42枚,无院内及手术相关死亡。所有患者术后均得到随访,随访时间(18.0±9.2)个月,1例患者因钝缘支狭窄、1例患者因右冠状动脉支架内狭窄再次接受经皮冠状动脉介入治疗。全组无心肌梗死及死亡。结论分站式杂交手术治疗多支冠状动脉血管病变安全有效,近中期效果良好。

Objectives To summarize the clinical experience of stage Ⅱ hybrid procedure [ coronary artery bypass grafting via left anterior minithoracotomy （MIDCAB） and percutaneous coronary intervention （PCI） ] for treating patients with muhivessel lesions. Methods A total of 26 coronary artery disease patients with multivessel lesions including left anterior descending artery （LAD） stenosis were treated in The Seventh Hospital of Zhengzhou from January 2011 to October 2014. All the patients received stage Ⅱ hybrid coronary artery revascularization. There were 17 male patients and 9 females, ranging from 36 to 81 years old [average age was （54.3±8.5） years]. The endpoint was survival rate with no major adverse cardiac and cerebrovascular events （MACCE）. Results All the patients received successful stage Ⅱ hybrid coronary artery revaseularization by vascular transplantation from left internal mammary artery （LIMA） to LAD, and 42 drug-eluting stents （DES） were implanted. There was no in-hospital death or surgery related death. All the patients were followed-up for （18.0±9.2） months. During the period, 1 patient had obtuse marginal branch stenosis and 1 patients had in-stent stenosis in the right coronary artery, both of which received redo-PCI. No myocardial infarction or death occurred. Conclusions Stage Ⅱ hybrid coronary artery revascularization is feasible and safe for treating patients with multivessel lesions, and the early-middle term effect is good.