联合冠状动脉搭桥及其相关心脏手术134例分析

目的:回顾分析联合冠状动脉搭桥及其相关心脏手术的临床效果。方法:134例患者中,75.4％有Ⅲ-Ⅳ级心绞痛(CCSS),冠状动脉造影示梗阻性病变在左主干(LM)34例次、左前降支(LAD)130例次、对角支91例次、回旋支84例次、右冠状动脉80例次。伴有冠状动脉弥漫性病变41例。左室射血分数(LVEF)18%-69%,其中45％-30％ 50例,<30％ 13例,伴左心室壁瘤56例,同时伴瓣膜功能不全42例。全部患者均在体外循环下行冠状动脉搭桥手术,对36例伴有冠状动脉弥漫性病变者同期激光心肌打孔(TMR),同期左心室壁瘤切除三明治式缝合11例,巨大室壁瘤心内补片左室成形45例;同期心脏瓣膜手术42例。结果:人均旁路2.46支,6例患者需主动脉内球囊反搏(IABP)辅助11-54 h;二次开胸止血6例;室上速/房颤28例,室性心律失常10例,2例电转复,余均药物控制;全组手术死亡3例,死亡原因分别为严重低心排综合征(2例)和多脏器功能衰竭。其余病人手术后心绞痛等症状均缓解,心脏功能明显改善。随访4-60个月(平均12.7月),随访率89％,65例已恢复全日制工作。结论:与单纯冠状动脉搭桥相比,联合冠状动脉搭桥及其相关心脏手术时间长,操作复杂,但只要设计良好的手术方案,仍能取得满意的效果。

Combined Coronary Artery Bypass Grafting and Other Heart Surgical Procedures --Clinical Analysis of Consecutive 134 Cases

Objective: To retrospectively review clinical results of combined coronary artery bypass grafting (CABG) and other heart surgical procedures. Methods: Combined CABG and other heart surgical procedures have been done in 134 consecutive cases (144 males, 20 females, aged from 48 to 76 years with a mean age of 61. 7). Coronary angiograph shows that all patients have coronary stenosis with left main involved in 20 cases, and that 41 cases have diffused coronary artery disease. A total of 56 patients have post myocardial infarction left ventrical aneurysms, and 42 patients have valve dysfunction which need surgical correction. The percentage of left ventricular ejection fraction (LVEF) was equal to or lower than 45% in 63 patients and in 13 patients EF was less than 30%. All the patients received combined CABG under the support of cardiopulmonary bypass (CPB) and other heart surgical procedures (Transmyocardial laser revascularization in 36, valve procedures in 42, and left ventricle aneurysm resection or plasty in 56 patients simultaneously) . Results: The mean number of grafts was 2. 46 per patient. Intra-aortic balloon pump was required in 6 cases for 11 to 54 h postoperatively. Three patients died postop-eratively with mortality rate of 2. 2% (two from low cardiac output syndrome, and one from multiple organs failure). A total of 131 patients recovered and were discharged. Conclusion: Combined CABG and other heart surgical procedures are more demanding than CABG along but can be done with acceptable morbidity and mortality if good surgical plan can be designed and all the heart abnormalities can be corrected simultaneously.