“一站式”复合技术治疗冠状动脉多支病变临床及造影中期随访结果：附42例造影结果分析

目的通过临床和冠脉造影评价＂一站式＂复合技术旁路的中期通畅率及临床疗效。方法 2010.10～2011.12共42例接受＂一站式＂复合技术治疗患者随访观察,所有患者均免于主要心脏或脑血管不良事件（Major adverse cardiac or cerebrovascular events,MACCE）发生的生存率,同时行冠脉造影确认患者左内乳动脉（left internal mammaryar tery LIMA）旁路及非左前降支（left anterior descending artery LAD）靶血管药物支架通畅率。男37例,女5例,年龄64.3±9.6岁,平均随访时间18±8.9个月。结果 42例患者均无MACCE。患者心功能Ⅰ级19例,Ⅱ级23例。冠脉造影结果显示：LIMA旁路42支,狭窄1支,闭塞1支,通畅率95.2%（40/42）。药物支架植入靶血管52支,再狭窄5支。LIMA旁路闭塞后LAD再次支架植入1支,原支架再狭窄再次植入支架病变冠脉2支,再次支架植入治疗冠脉新发病变3支。非LAD病变冠脉通畅率82.7%（43/52）。结论 ＂一站式＂复合技术治疗冠状动脉多支病变患者术后18个月的LIMA-LAD旁路和非LAD靶血管的药物支架具有较高的通畅率,提示一站式复合技术治疗冠状动脉多支病变术后1年通畅率及临床疗效优于文献报道的单纯冠状动脉旁路移植术（Coronary artery bypass graftingCABG）或经皮冠状动脉介入治疗（Percutaneous coronary intervention PCI）的通畅率,其长期效果需要进一步随访。

Clinical and Angiographic Mid-term Results of "One-Stop" Hybrid Revascularization for Multivessel Coronary Artery Disease:Analysis of 42 Cases Angiographic Results

Objective " One-stop" hybrid coronary revascularization has emerged to be a reliable and attractive solution in the international cardiovascular field for selective patients with multivessel coronary artery disease.However,so far,there has been neither midterm nor long term angiogram result of the surgery.This study seeks to analyze our midterm angiogram results of the "one-stop" hybrid coronary revascularization.Methods Between October 2010 and December 2011,42 patients(mean age was 64.3±9.6 years,ranging from 54 to 77) including 37 males and 5 females,were enrolled in the present study and underwent a postoperative angiography after surgery(18 months on average).The angiograms were assessed visually and quantitatively.There were 19 cases in New York Heart Association NYHA 1,23 cases in NYHA 2..Clinical and angiographic follow-up lasted 18± 8.9 months.Results:There was no MACCE in all 42 cases.While LIMA bypass showed the best result in all conduits(95.2%,40/42),Drug eluting stent(DES) resulted in a patency of 82.7%(43/52).One LIMA graft occlude and was treated with DES when followed up.Two target vessels with stent restenosis and 3 new target vessels were retreated with stents when followed up.Conclusions:Our angiography showed that the left internal mammary artery(LIMA) graft patency of one-stop hybrid revascularization was as good as the results of the conventional surgery.And the non-left anterior descending artery(LAD) patency resulted from DES was better than that of the saphenous vein graft.So the one-stop hybrid revascularization surgery is reasonable,safe and feasible for patients with complex coronary artery disease.