“分站式”杂交冠状动脉血运重建术治疗73例冠状动脉多支血管病变临床中期随访结果分析

Mid-term Outcomes of “2-staged” Hybrid Coronary Revascularization in Treating 73 Patients With Multi-vessel Coronary Artery Disease

目的:观察"分站式"杂交冠状动脉血运重建术(HCR)治疗冠状动脉多支血管病变中期随访结果,评价"分站式"HCR的可行性、安全性和疗效。方法:入选2012-01至2014-06因冠状动脉多支血管病变在我院行择期"分站式"HCR的患者共73例,其中男性50例(68.5%),女性23例(31.5%),平均年龄(61.1±10.7)岁,所有患者均为包括左前降支在内的多支病变。"分站式"HCR要点为:全麻双腔气管插管,左前胸第4或第5肋间小切口,直视下获取左乳内动脉,心脏跳动下完成左乳内动脉和左前降支的吻合。在小切口冠状动脉旁路移植术(CABG)术后3~7天,在介入导管室先行冠状动脉造影,观察左乳内动脉-左前降支旁路血管情况,证实其通畅后对非左前降支病变行经皮冠状动脉介入治疗(PCI)并置入支架。患者术后每年进行超声心动图、X线胸片和心电图检查,如患者出现心肌缺血表现,则进行冠状动脉增强计算机断层摄影术(CTA)或冠状动脉造影检查等。结果:本组患者均顺利施行"分站式"HCR,全组无手术死亡。外科手术时间(152.9±43.8)min,处理冠状动脉(2.6±0.5)支,术后总引流量(558.6±441.3)ml,输红细胞(0.8±1.9)U,机械通气时间(10.5±13.0)h。小切口CABG与PCI间隔时间(5.3±2.9)d,冠状动脉置入支架(1.6±0.7)枚。术后随访期间,主要不良心脑血管事件(MACCE)发生5例(6.8%),其中死亡1例(1.4%),再发心肌缺血3例(4.1%),需要接受CABG/PCI者1例(1.4%,因支架再狭窄,再次置入支架)。结论:"分站式"HCR是一种安全,有效的手术方式,其围手术期和中期随访结果满意,"分站式"HCR适合于左前降支严重病变无法接受PCI而右冠状动脉主干和(或)回旋支等非左前降支病变可以进行PCI的冠状动脉多支病变患者。

Objective：To observe the midterm outcomes of ＂2-staged＂ hybrid coronary revascularization（HCR） for treating the patients with multi-vessel coronary artery disease（CAD） and to evaluate the feasibility,safety and efficacy of ＂2-staged＂ HCR.Methods：A total of 73 relevant patients received elective ＂2-staged＂ HCR in our hospital from 2012-01 to 2014-06 were studied.There were 50（68.5%） male and 23（31.5%） female at the age of（61.1±10.7） years and all patients had multi coronary artery lesions including left anterior descending（LAD） artery.The key points of ＂2-staged＂ HCR wereas follows：double-chamber intubation with general anesthesia,small incision between 4-5 ribs of left front thorax,take left internal mammary artery（LIMA） by direct view and make anastomosis of LIMA and LAD with heartbeat.At（3-5） days postminimally invasive direct coronary artery bypass（MIDCAB）,coronary angiography（CAG） was conducted to confirm that LIMA-LAD bypass vessel was unobstructed;then percutaneous coronary intervention（PCI） was performed in non-LAD coronary artery for stent implantation.Post-operative echocardiography,chest X-ray and ECG were examined in each year;coronary CTA or CAG would be taken if the patients with myocardial ischemia.Results：All patients finished ＂2-staged＂ HCR smoothly and no operative death occurred.The average surgical time was（152.9±43.8） min and（2.6±0.5） coronary branches were treated,total post-operative drainage volume was（558.6±441.3） ml,red blood cell transfusion was（0.8±1.9） U,mechanical ventilation time was（10.5±13.0） h.The interval between MIDCAB and PCI was（5.3±2） days and（1.6±0.7） stents was implanted.During post-operative follow-up period,there 1（1.4%） patient died,3（4.1%） with recurrent myocardial ischemia,1（1.4%） with in-stent restenosis and received PCI again,4（5.5%） with MACCE.Conclusion：＂2-staged＂ HCR is a safe and feasible operation with satisfactory peri-operative and mid-term outcomes;it is suitable for the patients with multi-vessel CAD including severe LAD lesions.