双侧乳内动脉在冠脉搭桥术中的应用

目的:探讨双侧乳内动脉在冠状动脉搭桥术中的应用价值。方法:行双侧乳内动脉冠状动脉搭桥手术患者37例,29例为3支病变,8例为左主干病变,13例术前有心梗,2例合并室壁瘤。36例在非体外循环下行冠状动脉搭桥手术,1例由OPCAB转为体外循环下冠脉搭桥。左侧乳内动脉(LIMA)到前降支及对角支,右侧乳内动脉(RIMA)到中间支、钝缘支及后降支。2例同时行室壁瘤切除,人均搭桥3.2支。结果:术后心梗导致低心排死亡1例。主动脉球囊反搏支持10例。术后出现切口感染1例,再次清创处理。随访12～39月(平均24.5个月),患者均无心绞痛再次发作。冠脉CTA检查显示双侧乳内动脉均通畅。结论:双侧乳内动脉在冠脉搭桥中,近期效果比较满意,远期效果尚待进一步随访。     

全动脉化非体外循环下冠状动脉旁路移植66例分析

目的 报告66例全动脉化非体外循环下冠状动脉旁路移植(OPCAB)手术的初步经验.方法 对66例择期患者施行了全动脉化OPCAB.桥血管主要取自左胸廓内动脉(LIMA )、右胸廓内动脉(RIMA)和桡动脉(RA).全动脉化桥血管组合包括LIMA9例,RIMA1例,LIMA+RA31例,LIMA+RIMA5例,LIMA+RIMA+RA20例.48例采用带蒂游离的方法获取IMA,另外18例采用骨架化技术获取.结果 本组无手术死亡病例,无围术期心梗病例,无因出血而再次开胸手术病例及深部切口感染病例.随访至今,无不良心血管事件发生.结论 全动脉化冠状动脉搭桥技术应用于OPCAB手术是安全可行的,它伴有较低的死亡率和并发症率,有满意的临床治疗效果,可以作为首次冠状动脉旁路术的首选方案.     

采用双侧乳内动脉的冠状动脉旁路移植手术体会

本组 16例患者采用双侧乳内动脉到左心系统的冠状动脉旁路移植手术 ,即右乳内动脉经过横窦与冠状动脉回旋支的主要分支吻合 ,左乳内动脉与冠状动脉前降支吻合的手术方法 ,现结合临床资料介绍手术的体会。临床资料一、一般资料本组共 16例 ,男 12例 ,女 4例 ,年龄 5 2～ 74岁 ,平均为 (6 4 .1± 6 .2 )岁。冠状动脉 2支病变 4例 ,3支病变 9例 ,4支病变 3例 ,总计搭桥 4 7支 ,平均搭桥 2 .94支。采用乳内动脉 32支 ,静脉桥 13支 ,桡动脉桥 2支。二、手术方法患者常规平卧位 ,正中开胸 ,先取左侧乳内动脉 ,连同乳内静脉及周围组织一起取下 ,左…     

冠状动脉搭桥术治疗冠心病临床分析

目的：探讨冠状动脉搭桥术（CABG）治疗冠心病的早期效果和经验。方法：26例冠心病患者接受CABG,术前心绞痛（CCS）Ⅰ级2例,Ⅱ级7例,Ⅲ级7例,Ⅲ级13例,Ⅳ级4例。24例浅低温体外循环下行CABG,2例非体外循环下施术。除1例左乳内动脉（LIMA）纤细血流不足改用大隐静脉外,25例采用LIMA与前降支搭桥,人均搭桥3．2支。结果：25例术后随访6－30个月,24例心绞痛症状完全消失,1例心绞痛Ⅰ-Ⅱ级。低心排术后死亡1例。结论：CABG治疗冠心病疗效确切,完全再血管化和围手术期处理是CABG功能的关键。     

诱导室颤法冠状动脉搭桥术

目的　回顾总结应用诱导室颤法进行冠状动脉搭桥术 6 8例的临床疗效。方法　自 1998年 8月至 2 0 0 0年 4月 ,6 8例中左主干病变 16例 ,单支血管病变 2例 ,2支血管病变 3例 ,3支血管病变 5 7例 ,有心肌梗死史 37例 ,糖尿病患者 11例 ,慢性肾功能不全 5例 ,脑卒中史 5例。左室射血分数 0 .45± 0 .11。应用左乳内动脉 (LIMA) 5 8例 ,右乳内动脉 (RIMA) 1例 ,双侧乳内动脉 (BIMA) 3例 ,桡动脉 6例 ,余采用大隐静脉移植。平均体外循环时间 (70± 49)min ,平均主动脉阻断时间 (2 5± 12 )min ,平均搭桥 (3.1± 1.9)支。心动超声检查比较手术前后左心功能改变。结果　手术死亡率 1.5 % ,围术期心梗发生率 1.5 % ,出血 2次开胸 3.0 % ,心房纤颤13.4% ,肾功能不全 6 % ,但无需透析治疗。术后无脑卒中、胸骨感染并发症。随访 12～ 2 4个月 ,所有患者均无心绞痛 ,心功能NYHAⅠ级 31例 ,Ⅱ级 37例。心动超声检查 ,2 1例左室射血分数从术前平均 0 .46增加到术后平均 0 .5 2 ,组织声像检查发现心肌血供有明显改善。结论　诱导室颤冠状动脉搭桥术是一种安全有效的治疗冠心病的外科手术方法。     

冠状动脉旁路移植术治疗冠心病42例

目的探讨冠状动脉旁路移植术（CABG）对冠心病的治疗效果。方法全组42例手术在全麻下进行，常规气管插管，均常规正中开胸，18例在体外循环（CPB）下手术，其余24例在非体外循环下行冠状动脉搭桥（OPCABG），取大隐静脉（SVG）与左乳内动脉（LIMA）同时进行，LIMA与前降支（LAD）搭桥42例，平均每例搭桥（2．4±0．8）支。结果全组均无死亡，平均手术时间（3.2±0．5）h，平均带气管插管时间（12±6）h。结论冠状动脉旁路移植术疗效显著，恢复和重建心肌血运确切，手术安全，效果令人满意。     

冠状动脉旁路移植术后乳内动脉桥血管病变相关因素分析

目的筛选、分析导致冠状动脉旁路移植术（CABG）后的患者左乳内动脉桥血管闭塞的危险因素。方法选取2002年1月—2006年8月在中国人民解放军总医院心血管外科高长青主刀完成的CABG术后患者共228例。通过64-MSCTA的方法判断CABG术后左乳内动脉桥血管通畅情况,收集患者术前、术中信息和术后资料,对可能导致左乳内动脉桥血管病变的危险因素进行单因素分析后,将筛选后的结果通过Logistic多因素回归分析,找出危险因素。结果术前冠脉造影前降支狭窄百分比、术前冠脉造影弥漫性病变;术前血糖;术前甘油三酯;术中检查靶血管直径;LIMA桥血流;同期室壁瘤手术为单因素危险因素,Logistic多因素回归分析,显示LIMA桥病变的危险因素是靶血管的狭窄程度和LIMA桥血流量。结论 LIMA桥通畅率和靶血管狭窄程度、桥血流相关。     

心脏不停跳下双桥技术治疗冠状动脉前降支弥漫性病变

目的：评价心脏不停跳冠脉搭桥“双桥”技术在冠状动脉前降支弥漫性病变治疗中的安全性和有效性。方法2008年10月-2012年12月,我院对36例前降支弥漫性病变患者在心脏不停跳下采用“双桥”技术治疗,其中男26例,女10例;年龄46~78（63.8±7.3）岁;双支病变3例,三支病变33例,其中合并左主干病变8例;术前欧洲心血管手术危险因素评分系统（European system for cardiac operative risk evaluation,EuroSCORE）评分为2~7（5.2±1.4）分;左心室射血分数为32.8%~65.0%（49.4±12.2）%。结果所有患者手术均成功,无住院死亡。其中左乳内动脉与前降支狭窄近端搭桥26例,桡动脉和大隐静脉与前降支狭窄近端搭桥分别为3例和7例;大隐静脉与前降支狭窄远端搭桥20例,桡动脉与前降支狭窄远端搭桥16例。平均搭桥3~5（3.2±0.6）支。术后平均呼吸机辅助通气时间、监护室停留时间和住院时间分别为6~16（11.3±2.9） h、9~22（16.5±4.2） h和5~9（6.9±1.4） d。平均随访0.5~4.8（2.8±1.4）年,所有患者均存活,无心绞痛发作。结论前降支“双桥”技术可以安全用于冠状动脉前降支弥漫性长病变患者的不停跳冠脉搭桥手术治疗,疗效可靠。     

78例冠状动脉搭桥术的体会

目的 总结78例冠状动脉搭桥术（CABG）的体会。方法 对78例经冠状动脉造影确诊后的冠心病患者进行CABG，其中在体外循环（CPB）心脏停搏下行CABG63例。CABG 二尖瓣置换术1例，非体外循环下行CABG14例；每例搭桥1-5支，平均3.1支，共搭桥248支；血管桥材料为内乳动脉（IMA）74支（LIMA73支，RIMA1支），余均为大隐静脉。结果无1例患者死亡，术后并发围术期心肌梗死2例，术后因出血行二次开胸止血1例，胸骨哆开3例。应激性溃疡5例；术后随访13-62个月，2例患者于术后8个月及14个月心绞痛症状复发需服药治疗，其余心绞痛症状均消失，心功能显著改善，生活质量明显提高。结论 CABG是治疗冠心病的有效方法。严格掌握手术指征。选择合理的手术方式，提高手术技巧。充分的术前准备，良好的心肌保护及术后早期监护是开展CABG，提高手术疗效的关键。     

冠状动脉旁路移植术21例临床分析

目的评价冠状动脉旁路移植术(Coronaryarterybypassgrafting,CABG)治疗冠心病的临床效果。方法对21例冠心病患者进行冠状动脉旁路移植术手术。单支血管病变2例,两支血管病变2例,三支17例(合并左主干狭窄1例)。采用大隐静脉(SV)及左内乳动脉(LIMA)作为移植物材料。结果术中共搭桥50根,应用LIMA10根,搭桥同期行主动脉瓣替换术1例,二尖瓣替换术1例,腹主动脉人工血管置换1例,术中术后应用主动脉内球囊反搏(IABP)3例;手术后死亡3例;存活18例,病人术后心绞痛症状消失,生活质量明显提高。结论对药物及介入治疗无效的冠心病病人采用冠状动脉旁路移植术是最有效的方法。     

Coronary artery bypass grafting for Kawasaki disease

Background Kawasaki disease （KD） is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting （CABG） in patients with KD. Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient （mean 2.5±0.8）. Various bypass grafts were used in patients, i.e. the left internal mammary artery （LIMA） in 3 patients, bilateral internal mammary artery （IMA） in 2 patients, LIMA plus gastroepiploic artery （GEA） in 1 patient and total saphenous vein grafts （SVGs） in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass （CPB）, after being supported with intra-aortic balloon pump （IABP）, the patient was weaned from CPB successfully. Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months （mean 27 months）, clincal angina disappeared or improved. Cardiac function was in Class I-II （NYHA）.Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.     

CABG术后冠状动脉竞争血流对LIMA血流ET、NO含量的影响

目的:研究冠状动脉分流(CABG)术后冠状动脉竞争血流对左乳房内动脉(LIMA)桥血流中内皮素(ET)、一氧化氮(NO)含量的影响,探讨动脉桥血管早期衰坏的分子机制。方法:建立猪CABG术后桥血管竞争血流动物模型,利用血流闭塞器造成冠状动脉不同程度狭窄,测量桥血管血流量及方向变化,并采用放射免疫分析法及硝酸还原酶法分别检测LIMA桥血流中ET、NO含量并进行对比分析。结果:冠状动脉左前降支(LAD)近端狭窄程度越轻,LIMA桥血流量越少;LAD近端未完全闭塞时,LIMA桥均出现双向血流。CABG术后LIMA桥血流ET含量明显高于移植前(P<0.05),NO含量明显低于移植前(P<0.05)。LAD近端冠脉竞争血流越大,LIMA桥血流NO含量越低。LIMA桥血流NO含量与LIMA桥血流量呈正相关(r=0.957,P<0.05)。LAD近端30%狭窄时,NO含量明显低于LAD近端90%狭窄及全部闭塞时(P<0.05),LAD近端50%狭窄时,NO含量明显低于LAD近端全部闭塞时(P<0.05)。LIMA桥血流ET含量有随LAD近端冠脉竞争血流增加而升高的趋势,但差异无统计学意义(P>0.05)。结论:来自未完全闭塞冠状动脉的竞争血流可引起LIMA桥血流量下降,产生双向血流,并导致桥血流中NO含量显著下降。     

Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

Background Total arterial revascularization （TAR） was widely utilized in coronary artery bypass grafting （CABG） as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery （RA） gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG.
Methods From January 2000 to December 2006, 85 patients （56 male and 29 female） at a mean age of 57.0 ± 5.2 years, underwent TAR in CABG. RA and left internal mammary artery （LIMA） with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed.
Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 ± 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92 to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One （1.2%） patient died, 3 patients （3.5%） experienced acute renal failure and 2 （2.4%） developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 ＋ 4.1 months （6-67 months）. Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 ±0.09, compared with that of 0.43 ± 0.11 preoperatively （P=-0.027）. Postoperative mean New York Heart Association class was 2.5±0.5, compared with that of 3.0±0.4 preoperatively （P=-0.003）.
Conclusions T     

Total Arterial Revascularization with Internal Mammary Artery or Radial Artery π Graft Configuration

The superior short-and long-term patency ofthe left internal mammary artery(LI MA)hasmade it the conduit of choice in myocardial revas-cularization.Abandonment of traditional pedicleharvestingtechniqueinfavor of a semi-skeletonizedone[1,2]allows for maxi mal utilizable LI MAlength.In the selected patients for the manage-ment of triple vessel disease with middle diagonal/intermediate ramus disease such that a skip withthe LI MAto the LAD will not work and the RI MAcannot pick upthe diago…     

Total Arterial Revascularization with Internal Mammary Artery or Radial Artery Graft Configuration

To investigate the clinical use of π graft in total arterial revascularization and its outcomes, a retrospective analysis of 23 patients out of 1000 patients undergoing total arterial coronary bypass surgery with a π graft between September 1994 and December 2004 was performed. In the selected patients for the management of triple vessel disease with middle diagonal/intermediate ramus disease such that a skip with the left internal mammary artery (LIMA) or radial artery (RA),the main stem of π graft, to the left anterior descending coronary artery (LAD) will not work and the right internal mammary artery (RIMA) or right gastroepiploic artery (RGEA) cannot pick up the diagonal/intermediate ramus, hence the LAD and diagonal/intermediate ramus were grafted with a mini Y graft using the distal segment of LIMA, RIMA, RA or RGEA, together with the bilateral internal mammary artery (BIMA) or LIMA-RA T graft to compose π graft. Twenty-three patients (18 males, 5 females) underwent the π graft procedure. There were no deaths or episodes of myocardial infarction, stroke, and deep sternal wound infection. One patient required reopening for controlling bleeding. Until the end of 2004, during a mean follow-up of 81.0 ±28.4 months, no angina needing re-intervention or operative therapy or coronary related death occurred. In conclusion, in patients with specific coronary artery anatomy/stenosis, the BIMA (sometimes LIMA with RA or RGEA) π graft can be successfully performed for total arterial revascularization with good midterm outcomes.     

20例冠状动脉搭桥手术的初步体会

自1987年6月至1989年9月,共施行冠状动脉搭桥手术(CABG)20例,其中2例术中死亡,存活18例。搭桥血管数55支,人均2.75支,其中10例采用LIMA,其余均采用大隐静脉。1例病人术中行冠状动脉腔内球囊扩张成形术(OTCA)。     

冠状动脉不同狭窄程度的竞争血流对旁路移植乳房内动脉血管桥血流的影响

目的：研究冠状动脉不同狭窄程度的竞争血流对旁路移植乳房内动脉（IMA）血管桥血流的影响。方法：选用中华小型猪，建立猪冠状动脉分流术（CABG）后IMA桥血管竞争血流动物模型，在冠状动脉左前降支（LAD）近端不同狭窄情况下，用即时血流检测仪（TTFM）分别测量LAD吻合口近端、远端、左侧乳房内动脉（LIMA）桥血流量及方向、波形、搏动指数（PI）值，并进行对比分析。结果：LAD近端完全开放、30％、50％、75％、90％狭窄、全部闭塞时LIMA桥平均血流量分别为(9.75±1.45)、(11.63±1.69)、(15.63±2.26、(19.75±2.37)、(23.50±2.34)和（26.75±2.11）ml/min；PI值分别为4.4±1.7、4.1±1.6、4.2±1.9、3.7±1.8、3.3±1.6、2.5±1.4。LAD近端90％狭窄及全部闭塞时LIMA桥的血流量均明显高于LAD近端完全开放、30％狭窄、50％狭窄时的血流量(P<0.01)，各组PI值相比，差异无统计学意义（P>0.05）。LAD近端未完全闭塞时LIMA血管桥均可出现双向血流，LAD近端各种狭窄程度LAD远端血流量差异无统计学意义（P>0.05）。结论：冠状动脉竞争血流确实存在。来自未完全闭塞冠状动脉的竞争血流造成的桥血流量减少和血流方向改变可能是造成CABG术后早、中期IMA血管桥衰坏的重要因素。     

Midterm Follow-up of Coronary Artery Bypass Grafting with 64-Slice Multi-detector Computed Tomography:Identification of Risk Factors Affecting Graft Patency

Objective To identify the risk factors that are associated with the midterm coronary artery bypass grafting (CABG) functionality by assessing patency of left internal mammary artery (LIMA) graft and saphenous vein (SV) graft with 64-slice multi-detector computed tomography (64-MDCT). Methods Patients who underwent CABG operation and postoperative 64-MDCT follow-up examinations from August 2012 to December 2015 were included. The graft patent status was classified into patent and poor patent according to MDCT findings predominantly on 3D reconstructed images by two radiologists. The clinical data and imaging findings of the patients were collected and compared between the patent group and poor patent group. Univariate analysis and the multivariate logistic regression analysis were performed to identify the risk factors that affect graft patency. Results Among 341 patients in the study, there were 330 LIMA grafts [326 anastomosed to the left anterior descending artery (LAD), 4 to right coronary artery (RCA)] and 564 SV grafts (SVG) [100 anastomosed to the diagonal branch (D), 226 to the obtuse marginal branch (OM), and 238 to the RCA territory]. The approximal vessel stenosis exceeding 90% occurred in 268 of 292 patent LIMA grafts, and in 1 of 34 poor patent grafts (χ2=167, P<0.001). The patency rate was higher when SVG was anastomosed to OM (85.4%) or RCA territory (81.9%) than to D (69.0%) ( χ2=15.471, P=0.004). The proximal target vessel stenosis<90% ( OR=0.015, 95% CI: 0.01-0.14, P=0.000) was independently associated with the closure risk of LIMA grafts, the dyslipidemia (OR=1.52, 95% CI: 1.0-2.5, P=0.048), history of diabetes (OR=1.28, 95% CI : 0.90-2.26, P=0.045) and typical angina symptoms (OR=1.81, 95% CI :1.33-4.15, P=0.003) were independently associated with the closure risk of SVG. Conclusions The proximal LAD stenosis less than 90% was adversely associated with graft patency in LIMA recipients; dyslipidemia, diabetes and angina symptoms were associated with the midterm failure in SVG recipients. The choice of the target anastomosis sites may affect the patency of SVG.