冠状动脉旁路移植术治疗冠心病合并中度缺血性二尖瓣反流的近远期疗效分析

Short-term and long-term curative efficacy of coronary artery bypass grafting in the treatment of coronary heart disease complicated with moderate ischemic mitral regurgitation

目的:评估单纯冠状动脉旁路移植术(CABG)治疗冠心病合并中度缺血性二尖瓣反流的近远期效果,以探讨最佳的治疗方案。方法:2009年1月至2018年12月,共有822例冠心病合并中度缺血性二尖瓣反流的患者在首都医科大学附属北京安贞医院接受治疗,其中750例行单纯冠状动脉旁路移植术(CABG组),72例同期行二尖瓣修复(MVP)或二尖瓣置换术(MVR)(CABG+MV组),通过倾向性评分匹配后(5:1匹配),共有384例患者纳入分析,其中CABG组320例,CABG+MV组64例。通过对比,评估两组患者外科治疗术后的效果。结果:两组患者均成功接受了手术治疗。围术期患者死亡19例,其中CABG组17例(5.3%),CABG+MV组2例(3.1%),两组间比较差异无统计学意义(P=0.461)。围术期发生MACCE事件21例,其中CABG组18例(5.6%),CABG+MV组3例(4.7%),两组间比较差异无统计学意义(P=0.763)。患者术后随访时间为(51.48±21.59)个月,期间死亡59例,其中CABG组50例(15.6%),CABG+MV组9例(14.1%),两组间比较差异无统计学意义(P=0.752)。随访期间发生MACCE事件80例,其中CABG组67例(20.9%),CABG+MV组13例(20.3%),两组间比较差异无统计学意义(P=0.911)。累积生存率(P=0.88)及MACCE事件免除率(P=0.77)两组间比较差异也无统计学意义。结论:对于冠心病合并中度缺血性二尖瓣反流的患者,单纯行CABG术与CABG+MV术相比,近远期疗效相当。

Objective:To evaluate the short-term and long-term efficacy of coronary artery bypass graft(CABG)alone in the treatment of coronary heart disease complicated with moderate ischemic mitral regurgitation,and to explore the best treatment strategy.Methods:From January 2009 to December 2018,a total of 822 patients with coronary heart disease complicated with moderate ischemic mitral regurgitation received surgical treatment in Beijing Anzhen Hospital Affiliated to Capital Medical University,of which 750 patients underwent coronary artery alone,bypass transplantation(CABG group).72 patients underwent mitral valve repair(MVP)or mitral valve replacement(MVR)at the same time(CABG+MV group),after matching by propensity score(5:1 matching),a total of 384 patients were included in the analysis,including 320 in the CABG group and 64 in the CABG+MV group.The short-term and long-term mortality and complication rates after surgery were compared between the two groups.Results:Both groups were successfully treated with surgery.19 patients died in the perioperative period,including 17 patients(5.3%)in the CABG group and 2 patients(3.1%)in the CABG+MV group.There was no significant difference between the two groups(P=0.461).There were 21 cases of MACCE events in the perioperative period,including 18 cases(5.6%)in the CABG group and 3 cases(4.7%)in the CABG+MV group.There was no significant difference between the two groups(P=0.763).The postoperative follow-up time was(51.48±21.59)months,and 59 cases died,including 50 cases(15.6%)in the CABG group and 9 cases(14.1%)in the CABG+MV group.There was no significant difference between the two groups(P=0.752).There were 80 cases of MACCE events during postoperative follow-up,including 67 cases(20.9%)in the CABG group and 13 cases(20.3%)in the CABG+MV group.There was no significant difference between the two groups(P=0.911).There was no significant difference in cumulative survival rate(P=0.88)and MACCE event exemption rate(P=0.77)between the two groups.Conclusions:For the treatment of coronary heart disease complicated with moderate ischemic mitral regurgitation,CABG alone has comparable short-term and long-term efficacy compared with CABG+MV.