冠状动脉粥样硬化性心脏病并中度二尖瓣反流行单纯冠状动脉旁路移植术疗效分析

Long-term effect of isolated coronary artery bypass grafting in the treatment of coronary artery disease with moderate ischemic mitral regurgitation

目的分析冠状动脉粥样硬化性心脏病(冠心病)合并中度缺血性二尖瓣反流(IMR)患者行单纯冠状动脉旁路移植术(CABG)术后疗效及影响因素。方法回顾性分析2002年6月至2012年9月解放军总医院63例接受单纯CABG外科治疗的冠心病合并中度IMR患者临床资料,其中男49例,女14例;年龄41~83(63.1±9.2)岁。根据末次随访超声心动图结果,将患者分为无反流组(二尖瓣无反流+微量反流)与残余反流组(二尖瓣少至中量反流),其中无反流组39例(男31例、女8例),年龄(62.9±8.5)岁;反流组24例(男18例、女6例),年龄(63.3±10.4)岁。收集患者术前、术后出院时及随访的超声心动图结果,记录术后残余IMR程度,检测术后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)以评估患者左心室重构的逆转;并且记录术后并发症、心功能及生活质量改善情况等。对两组患者数据进行比较及影响因素。结果住院期间死亡1例,死于术后低心排出量综合征。超声心动图检查提示:全组患者均未出现IMR程度进一步加重,术后IMR面积与术前比较明显下降;术后LVEDD与术前比较明显减小[(48.0±5.8)mm vs(54.6±5.54)mm,P<0.01];LVEF较术前显著升高[(45.3±9.9)%vs(41.3±8.4)%,P<0.01]。全组随访5~15年,随访期间死亡18例(6例为心源性死亡,余12例为非心源性死亡),失访6例,共有效随访56例(88.9%)。无反流组术后LVEDD较残余反流组更小(P=0.041<0.05);术后LVEDD是术后存在IMR的危险因素。结论对于冠心病合并中度IMR患者,单纯CABG术远期疗效好,术后LVEDD是影响术后IMR的危险因素。

Objective To analyze the long-term effect of isolated coronary artery bypass grafting（ CABG） in the treatment of coronary heart disease with moderate ischemic mitral valve regurgitation（ IMR） and its influencing factors. Methods Clinical data of the 63 patients with coronary heart disease and moderate IMR who underwent isolated CABG in our hospital from June 2002 to September 2012 including 49 males and 14 females with their mean age of 63.1±9.2 years were collected and analyzed. Patients were divided into no regurgitation group（ no or trace amount of mitral regurgitation） and residual regurgitation group（ mild to moderate amount of mitral regurgitation） according to the results of transthoracic echocardiography（ TTE） at the end of follow-up. TTE data,complications,cardiac function and life quality were collected immediately after operation,at discharge from hospital,3 months,6 months,1 year postoperatively and every year after operation. Results One patient died in hospital of low cardiac output after surgery. The postoperative mitral regurgitation area decreased significantly after operation. Left ventricular end diastolic diameter（ LVEDD） decreased significantly（ 54.6±5.54 mmvs 48.0 mm±5.8 mm,P〈0.01）. Left ventricular ejection fraction（ LVEF） was significantly higher than that before the operation（ 41.3± 8.4% and 45.3± 9.9% ,P〈0.01）.The patients were followed up for 5 to 15 years. Eighteen patients died during the follow-up period,6 patients were lost to follow-up and 56 were followed up effectively（ 88. 9% ）. Multivariate analysis showed that postoperative LVEDD is a risk factor affecting the long-term survival. Conclusion The treatment of coronary artery disease with moderate IMR by CABG alone is effective and has good long-term efficacy. The postoperative LVEDD may affect the longterm survival.