80岁及以上不停跳冠状动脉旁路移植手术患者的短期和长期临床结果探讨

Short-term and long-term outcomes of off-pump coronary artery bypass grafting in patients aged 80 years and over

目的探讨高龄冠心病患者行不停跳冠状动脉旁路移植手术(OPCAEG)的短期和长期临床结果。方法回顾性分析北京安贞医院2005年6月至2014年7月31例80岁以上合并左心功能不全接受单纯OPCAEG手术治疗的冠心病患者院内和出院后3-12年的随访资料。结果患者80-88岁,平均(82.0±2.1)岁,男25例(80.6%),术前平均左心室射血分数(LVEF)(42.0±6.5)%,其中LVEFV35%有15例(48.4%)。平均手术时间4 h,院内死亡3例(9.7%),其中1例急性呼吸衰竭,另2例死因为低心排综合征。围术期心肌梗死1例(3.2%),急性脑梗塞2例(6.5%),再次气管插管3例(9.7%),二次开胸止血1例(3.2%),术后持续肾替代治疗3例(9.7%),围术期使用主动脉球囊反搏(IABP)8例(25.8%)。术前使用IAEP2例,术中2例,术后4例。术后随访3-12年,中位时间8年。术后随访28例,随访率100%,全因死亡10例(35.7%),心源性死亡5例(17.9%),肺癌死亡2例(7.1%),全身感染性脓毒血症死亡2例(7.1%),1例不明原因猝死。再次入院2例(7.1%)。再发心绞痛2例(7.1%)。再发心肌梗死1例(3.6%),无再次接受血运重建治疗。术后1年所有存活患者行冠状动脉计算机断层血管造影(CTA)检查,桥血管通畅率达100%。结论80岁及以上合并左心功能不全接受单纯OPCAEG手术治疗的冠心病患者短期和长期临床结果尚可接受,但死亡率和并发症风险较高,需术前全面评估。

Objective To investigate short-term and long-term outcomes of off-pump coronary artery bypass grafting(OPCABG)in patients aged 80 years and over.Methods In this retrospective study,clinical data were collected»from June 2005 to July 2014,of 31 patients aged 80 and over years with left ventricular dysfunction who had received OPCABG in Beijing Anzhen Hospital and a followup of 3-12 years after discharge.Results Ages of the patients ranged from 80 to 88 years with a mean age of(82.0±2.1)years.There were 25 males(80.6%).The mean left ventricular ejection fraction(LVEF)of patients was(42.0±6.5)%before operation,and 15 patients had LVEF less than 35%(48.4%).The average operation time was 4 hours.Three patients died in hospital(9.7%),of whom,one died from acute respiratory failure and the two others from low cardiac output syndrome.Perioperative complications included myocardial infarction(1 case,3.2%),acute cerebral infarction(2 cases,6.5%),tracheal intubation(3 cases,9.7%),secondary thoracotomy and hemostasis(1 case,3.2%),continuous renal replacement therapy(3 cases,9.7%)and perioperative intra-aortic balloon pump(IABP)(8 cases,25.8%).Twenty-eight patients were followed up for 3-12 years(median,8.0 years),and no one had withdrawn.There were 10 all-cause deaths(35.7%),including 5 cardiogenic deaths(17.9%),2 lung cancer deaths(7.1%),2 deaths due to sepsis from systemic infection(7.1%),and 1 death from unknown causes.Besides,2 patients had re-admission(7.1%),2 patients suffered angina(7.1%)and 1 patient(3.6%)had recurrent myocardial infarction(3.6%).No patient received re-revascularization.Coronary computed tomography angiography(CT A)was performed on all surviving patients 1 year after surgery,and the patency rate of vascular bridges was 100%.Conclusions Both short-term and long-term clinical outcomes of OPCABG are fair in patients aged over 80 years with left ventricular dysfunction,but the mortality and risk of complications are still high,and comprehensive preoperative evaluation is needed for these patients.