中、重度左室功能减退的冠状动脉旁路术

Coronary Artery Bypass Grafting in Patients With Moderate or Severe Left Ventricular Dysfunction

目的:总结评价左室功能明显减退的冠状动脉搭桥术(CABG)的外科治疗结果。方法:1993年5月至2002年12月对因长期慢性心肌缺血造成心室功能明显减退的96例冠心病患者进行CABG,男性92例,女性4例,年龄42-78岁,平均(65.2±7.2)岁。左室功能明显减退(LVEF)0.30-0.40的64例,0.20-0.29的26例,0.10-0.19的6例。结果:50例联合应用左胸廓内动脉与前降支吻合,46例单纯大隐静脉搭桥,人均3.10支。手术死亡2例。术后随访3-82个月,平均(39.6±14.2)个月,死亡3例。LVEF均有改善0.08-0.20,生活质量明显提高。结论:左室功能明显减退的冠心病患者,进行CABG有令人满意的手术成功率和良好的近、中期效果,手术能改善患者的心脏功能和生活质量。

Objective: To evaluate the clinical outcome after coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction. Methods: From May 1993 to December 2002,96 consecutive patients with a left ventricular ejection fraction (LVEF) < or =0. 4 underwent isolated CABG including 92 males and 4 females, ranging from 42 to 78 with a mean age of 65. 2±7. 2 years. Pre-operative LVEF was 0.3-0.4 in 64 patients, 0.20-0.29 in 26 patients and 0.10-0.19 in 6 patients. Results: A left internal mummary artery (LIMA) was used in 55 patients. Only venous conduits were used in 41 patients. Mean number of grafts per patient was 3. 1 (range 1-5). Thirteen patients had postoperative low cardiacoutput syndrome, requiring intra-aortic balloon pump (IABP). There was two patient deaths with mortality rate of 2. 08%. The cause of death was heart failure. The average follow-up lasted 39. 6±14.2 (range 3-82) months. There were three late deaths. The patients LVEF increased 0.08-0.20 postoperatively. Quality of life improves significantly in most patients. Conclusion: Myocardial revascularization in patient with left ventricular dysfunction can be performed with an acceptably low operative risk and excellent early and mid-term clinical results. CABG leads to a good survival rate and improved quality of life.