心脏不停跳下行瓣膜置换及冠状动脉旁路移植术

目的 总结心脏不停跳下瓣膜置换及冠状动脉旁路移植术的体会,并评估其疗效.方法 对2005年1月至2007年8月12例同时合并冠状动脉粥样硬化性心脏病和心脏瓣膜病的病人进行手术.病人术前均存在心绞痛症状,心功能为Ⅱ～Ⅳ级,术前射血分数平均0.53±0.23.不停跳下进行冠状动脉旁路移植及瓣膜置换术,比较术前及术后相关心功能指标.结果 病人均痊愈出院.平均移植血管(3.4±1.5)支.复查时所有病人均无症状.心功能及射血分数均显著提高(P<0.001).结论 在心脏不停跳下行瓣膜置换及冠状动脉旁路移植术可行,并发症少.术后早期心功能、自主症状及生活质量均显著改善.远期疗效尚需观察.

Valve replacement and coronary artery bypass grafting on beating heart

Objective To evaluate the resuts of valve replacement and coronary artery bypass grafting on beating heart.Methods From January 2005 to August 2007, 12 patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60.4 years. All patients presented with symptoms of angina. Heart function class Ⅱ (NYHA) in 6 patients, class Ⅲ in 4 and class Ⅳ in 2.7 patients had mitral valve lesion, 3 aortic valve lesion, and 2 with lesions of both valves. 4 cases had donble-vessal disease, and 8 with triple-vessel disease. Preoperative ejection fraction was 0.53±0.23. Operation was completed on the beating heart to minimize ischemia and maintain cardiac function. The left mammary artery was grafted to the left anterior descending artesy first. Then distal anastomosis of the saphenous vein to the target vessels was performed followed by valve replacement. Proximal anastomosis d the saphenous vein to the aorta was finally finished on beating heart. The ventricular preoperative and postoperative performances were compared. Results All patients discharged without complications. Coronary artery bypass was performed with an average d ( 3.4±1.5) grafts per patient. At the time of follow-up, all patients had no symptoms. The mean NYHA class and ejection fraction improved significantly ( P < 0.001) .Conclusion These results suggest that this surgical method can be performed safely. A postoperative improvement in the early-term cardiac functions and symptams and quality of life was documented.