全动脉化冠状动脉旁路移植术治疗左心功能低下冠心病多支病变的回顾性队列研究

Total arterial revascularization for patients with coronary artery disease and left ventricular dysfunction:A retrospective cohort study

目的评估左心室功能低下的冠状动脉粥样硬化性心脏病(冠心病)患者行全动脉化冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的手术效果。方法回顾性分析2016年1月—2019年7月在遵义医科大学附属医院行CABG且左心室射血分数(left ventricular ejection fraction,LVEF)≤40%冠心病患者的临床资料。根据桥血管的不同将患者分为全动脉化血运重建组(TAR组)和常规组(CON组)。比较两组数据,探讨全动脉化CABG的安全性和对心功能的影响。结果共纳入75例患者,其中男52例、女23例,年龄(61.58±7.93)岁。TAR组35例,CON组40例。TAR组手术时间和术后24 h引流量均长于或多于CON组(P<0.001),而两组住院时间、术后并发症(如呼吸功能衰竭、纵隔感染、肾功能衰竭)以及主动脉内球囊反搏、体外膜肺氧合使用率差异均无统计学意义(P>0.05)。随访2年,TAR组患者心功能明显改善,LVEF值更高,左心室舒张末期内径更小,且桥血管狭窄率更低(P均<0.05)。结论低LVEF患者行全动脉化CABG有助于改善心功能、提高生活质量,是一种安全可行的治疗方式。

Objective To compare the superiority of total arterial revascularization in patients with coronary artery disease(CAD)complicated with left ventricular dysfunction.Methods This retrospective study included the patients who were diagnosed with CAD and the left ventricular ejection fraction(LVEF)of≤40%and underwent coronary artery bypass grafting(CABG)at our hospital from January 2016 to July 2019.The patients were divided into two groups according to the different types of bypass vessels:a total arterial revascularization group(TAR group)and a conventional group(a CON group).The clinical data were compared between the two groups to explore the incidence of important complications and evaluate the safety of total arterial revascularization and its protective effect on cardiac function.Results Finally 75 patients were enrolled including 52 males and 23 females with a mean age of(61.58±7.93)years.There were 35 patients in the TAR group and 40 patients in the CON group.The operation time and the drainage volume at 24 hours after operation in the TAR group were longer or more than those in the CON group(P<0.001),but there was no statistical difference in hospital stay,postoperative complications(such as respiratory failure,mediastinal infection,renal failure),intra-aortic balloon pump or extracorporeal membrane oxygenation use rate(P>0.05).After 2 years of follow-up,compared with the CON group,the cardiac function of the TAR group was significantly improved,the LVEF was higher,the left ventricular end diastolic diameter was reduced,and the graft stenosis rate was lower(all P<0.05).Conclusion Total arterial revascularization is a safe and feasible surgical method,which is helpful to improve the cardiac function and improve the quality of life.