老年患者心脏瓣膜手术同期行冠状动脉旁路移植术的临床分析

目的探讨老年患者心脏瓣膜疾病合并冠状动脉粥样硬化性心脏病（冠心病）的外科治疗方式,总结经验,提高手术效果。方法回顾性分析24例老年患者同期施行冠状动脉旁路移值术和心脏瓣膜手术的临床资料及远期随访资料。二尖瓣病变14例,单纯主动脉瓣病变8例,主动脉瓣、二尖瓣联合病变2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。心脏复苏后完成大隐静脉与升主动脉的吻合,乳内动脉的吻合在换瓣后心脏复苏前完成。冠心病合并单纯二尖瓣病变患者14例,其中10例行瓣膜成形术,另外4例行二尖瓣置换。瓣膜置换手术中2例应用进口双叶机械瓣,其它均应用生物瓣,二尖瓣成形使用Carpentier环。结果术后早期死亡1例,死亡原因为严重低心排,另有2例患者术后发生低心排行主动脉内球囊反搏（IABP）辅助。随访23例,随访时间2个月~45个月,心绞痛不同程度消失,心功能明显改善。结论冠状动脉旁路移植术同期行瓣膜手术是安全、有效的;二尖瓣关闭不全患者行瓣膜成形,手术效果满意。

Clinical study of combined valve operation and coronary artery bypass grafting in old patients

Objective To review the experience of the combined coronary artery bypass grafting（CABG） and cardiac valve operations and improve the operative effects and decrease the operative mortality.Methods 24 old patients with coronary artery lesion and valve diseases were treated with myocardial revascularization combined with concomitant valve operation.There were 13 cases with mitral valve lesion,8 cases with aortic lesion,and 3 with both of the lesions.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（14 patients） or plasty（10 patients）.The left internal mammary artery（LIMA） was grafted to the left anterior descending artery（LAD） before aortic unclamping.Proximal anastomosis of the SV to the aorta was finally finished on beating heart.Results There was 1 patients died of low cardiac outlet syndrome.23 patients were followed up from 2 months to 45 months,whose angina disappeared and associated with improved heart function.Conclusion CABG combined with cardiac valve operation can be successfully performed in appropriate candidates with good results.