不停跳冠脉搭桥结合心肌激光血运重建术治疗严重冠心病的初步探讨

Combined Transmyocardial Laser Revascularization with Off-Pump Coronary Artery Bypass Grafting in Management of Patients with Severe Isehemic Heart Disease

目的 观察不停跳冠状动脉 (冠脉 )搭桥术结合经心肌激光血运重建术 (OPCAB/TMLR)的安全性和有效性。方法 对 10例多支冠脉有严重病变患者做OPCAB ,而对无法搭桥的心肌缺血区施以TMLR。结果 无手术死亡及重要术后并发症。平均随访 (18 1± 5 )个月 ,8例心绞痛完全消失 ,平均心绞痛分级由术前的 3 2± 0 8,减至 0 2± 0 4。所有病人均无需再服用硝酸酯类药 ,亦无因心脏事件而再住院者。EF由术前平均 5 3 2 %增加到 6 5 4 % ,左室壁运动计分也由术前的 13 95± 3 34降低至术后的 11 74± 1 34。生活质量显著提高。结论 OPCAB/TMLR是安全、有效的 ,对心肾功能欠佳的严重冠心病人较为可行 ,如非特殊情况 ,TMLR一般不宜作为冠心病的独立疗法 。

Objectives To assess the safety and effecacy of combining transmyocardial laser revascularization (TMLR) with off-pump coronary artery bypass grafting (OPCAB) in patients, who were not amenable to complete revascularization by coronary artery bypass alone. Methods From October 1999 to June 2002, 10 patients whose standand of care were off-pump coronary artery bypass grafting and who had one or more nongraftable areas which were treated with Holmium YAG laser transmyocardial revasculariaztion as an adjunt. Results The mean number of vessels bypassed was 2.6±4 and the mean number of laser channels was 19.5±9. All patients were uneventful in the early postoperative period. Mean follow-up was 18.1±5 months. At this time, all patients were alive and had good quality of life. Mean CCS angina class decreased significantly from the baseline of 3.2±0.8 to 0.2±0.4(P< 0.000 1), with 8 patients angina free. Non-patient had to use nitrates or readmit for cardiac events after operation. Mean resting left ventricular EF increased from baseline of 53.2% to 65.4% at follow-up, and left ventricular wall motion score was improved. Conclusions TMLR combined with OPCAB is a safe and effective surgical procedure to achieve complete myocardial revascularization in severe coronary artery disease patients with some ungraftable areas. As the long-term symptomatic benefits of sole TMLR is still uncertain, except in special conditions, it is best used as an adjunct to CABG.