冠状动脉旁路术同期瓣膜手术的体会

Myocardial revascularization combined with concomitant valve operations: report of 45 cases

目的 介绍冠状动脉旁路术 (CABG)同时行心脏瓣膜手术的体会。 方法 45例患者 ,平均年龄 5 9岁 ( 42～ 75岁 ) ;心功能 (NYHA)Ⅱ级 7例、Ⅲ级 30例、Ⅳ级 8例 ;二尖瓣病变 30例、主动脉病变 7例、联合瓣膜病变 8例 ,均伴有单支或多支冠状动脉病变。手术在中度低温体外循环下完成。心脏停跳后 ,先作静脉桥的远端吻合 ,然后置换瓣膜。心脏复苏后完成大隐静脉与升主动脉的吻合 ,或在升主动脉 1次阻断下完成。乳内动脉的吻合在换瓣后心脏复苏前完成。本组 6例行二尖瓣成形 ,31例行机械瓣置换 ,8例行进口生物瓣置换。 结果 本组患者无手术死亡。术后呼吸机使用时间平均 18 7h ,ICU监护 1 8d。住院时间平均 9 2d。随访 6个月～ 4年患者无死亡 ,心功能Ⅰ级 35例、Ⅱ级 10例。 结论 冠状动脉旁路移植术同时行瓣膜手术是安全、有效的。

Objective To introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation. Methods From 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class Ⅱ (NYHA) in 7 patients, Class Ⅲ in 30, Class Ⅳ in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomoses of the saphanous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal ananstomsis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min. Results No mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class Ⅰ-Ⅱ and no patient died during follow-up. Conclusions CABG combined with valve surgery can be safely performed with good results.