冠状动脉严重病变的高龄患者的非体外循环冠状动脉旁路移植术

Off pump coronary artery bypass in senilities

目的 总结冠状动脉严重病变的高龄患者行非体外循环冠状动脉旁路移植术 (OPCAB)的治疗经验。方法 回顾性分析 5 3例 ,年龄在 75～ 82 (77± 2 )岁 ,冠状动脉严重病变的患者行OPCAB的临床资料。 3支病变 4 4例 ,左主干病变 2 1例 ,前降支近端 90 %～ 10 0 %狭窄 2 5例 ,右冠状动脉近端 90 %～ 10 0 %狭窄 17例 ,急诊冠状动脉旁路移植术 13例。 5 3例OPCAB手术全部成功。平均远端吻合口数目 (3.0± 0 .8)个 ,移植物取乳内动脉 2 9例 ,大隐静脉 5 1例。结果 术后并发症 4例 :其中新发脑卒中 1例 ,2次开胸止血 1例 ,恶性心律失常 1例 ,多脏器功能衰竭 1例 ;主动脉内球囊反搏 7例 ;住院死亡 2例。随访时间 1～ 2 4 (10± 7)个月 ,均无急性心血管事件发生 ,非心脏性死亡 1例。

Objective To analyze the effect of off pump coronary artery bypass (OPCAB) in senilities with severe multivessel coronary artery obstruction.Methods This study included 53 patients (43 males and 10 females; mean age 77±2 years,ranging from 75 to 82 years old).Clinical presentation of New York Heart Association (NYHA) classification consisted of class Ⅱ (14 cases),class Ⅲ (10 cases) and class Ⅳ (1 case).The left ventricle ejection fractions (LVEF) were from 32% to 82%(mean 63±14%).There were 21 patients with left main branch disease,44 patients with three vessel disease,25 patients with left anterior descending disease with 90%～100% stenosis,17 patients with right coronary artery disease with 90%～100% stenosis.Thirteen patients underwent emergency operation.Of the 53 cases,OPCAB were performed successfully without cardiopulmonary bypass.Mean number of distal anastomoses was 3.0±0.8.Grafts used included 29 left internal mammary arteries and 51 saphenous veins.Results Two in hospital deaths occurred.Newly occurring stroke (1 case),rethoracotomy for bleeding (1 case),life threatening ventricular arrhythmia(1 case) and multiple system organ failure(1 case) were found as complications.Seven patients were assisted by intra aortic balloon pumping (IABP) in OPCAB procedure.The follow up ranged from 1 to 24 months(10±7)and no acute cardiac events were occurred in 50 cases besides only one death was no cardiac event.Conclusions OPCAB is a feasible and effective procedure for senilities than 75 years old bearing severe coronary artery diseases.