冠状动脉旁路移植术的中远期效果随访

目的 分析冠状动脉旁路移植术(CABG)的中、远期疗效.方法 CABG术后行多层螺旋CT(MDCT)复查42例,行冠状动脉造影(SCA)复查59例;平均随访(66.79±44.27)个月.其中动脉旁路血管115支,静脉旁路血管195支.分别计算旁路血管的通畅率,比较其间的差异.结果 行MDCT复查者随访(53.93±36.80)个月,LIMA、RA、SV和CV的通畅率分别为94.7%、92.0%、85.9%和60.0%;有心绞痛再发组为83.5%,无心绞痛再发组为95.2%,差异有统计学意义.SCA复查者随访(75.95±47.09)个月,LIMA、RA、SV和CV的通畅率分别为87.1%、81.0%、53.6%和57.1%;有心绞痛再发组为62.0%,无心绞痛再发组为100.0%,差异有统计学意义.结论 MDCT可以作为一种无创检查方法来评价CABG术后旁路血管的通畅情况;动脉旁路血管的中、远期通畅率较静脉高;旁路血管病变是导致术后再发心绞痛的重要原因;旁路血管病变程度与CABG术后的随访时间密切相关.     

冠状动脉竞争血流对乳内动脉旁路血流及NO、ET含量影响的实验研究

目的研究冠状动脉旁路移植（CABG）术后,未完全闭塞冠状动脉的竞争血流对左乳内动脉（加雌）旁路血流量、方向及旁路血流中一氧化氮（NO）、内皮素（ET）含量的影响。方法15只猪行㈣术建立不同程度狭窄的冠状动脉左前降支（LAD）与LIMA旁路血管竞争血流动物模型,并检测LIMA旁路血流中NO、ET含量。结果LAD近端狭窄程度越轻,LIMA旁路平均血流量越小,且收缩期逆向血流越大,IAD近端30％狭窄、50％狭窄时LIMA旁路的血流量均明显低于90％狭窄时（P〈0．01）。IAD近端30％和50％狭窄时旁路血流NO含量均明显低于IAD近端90％狭窄时（P〈0．05）;LIMA旁路血流中ET含量均较移植前高（P〈0．05）。结论CABG术后,来自未完全闭塞冠状动脉的竞争血流导致加雌旁路血流量下降并产生双向血流,进而引起旁路血流中NO含量显著下降,可能是早期LIMA血管旁路闭塞的主要机制。     

非体外循环心脏跳动下冠状动脉旁路移植术桥血流的研究

目的　术中测量非体外循环心脏跳动下冠状动脉旁路移植术 (OPCAB)桥血管的血流量和搏动指数 (PI)及血流波形 ,以探讨血管桥通畅率及其与波形的关系。方法　 2 34例病人接受OPCAB手术 ,采用左乳内动脉 (LIMA)全部与左前降支 (LAD)吻合 ,大隐静脉 (SV)吻合口在 2个以上采用序贯式吻合。术中用超声血流检测仪 (medi stimbutterflyflowmeter)测量旁路血管桥的血流量、PI值及其波形 ,根据结果判断桥路通畅情况 ,并且对比LIMA和SV旁路血管桥的血流量和LIMA中LAD近段狭窄大于 90 %与小于 90 %者的血流量。结果　LIMA使用率 10 0 % ,LIMA和SV桥通畅率 10 0 % ,LIMA平均血流量(19 99± 1 93)ml/min ,SV血流量 (38 17± 2 85 )ml/min ,两者差异显著 (P <0 0 1)。LIMA组中LAD近段狭窄大于 90 %者血流量 (32 0 0± 3.4 0 )ml/min ,小于 90 %者血流量 (15 2 9± 1 6 6 )ml/min ,两者差异显著(P <0 0 1)。PI平均值LIMA为 3 2 9± 0 2 2 ,SV为 3 4 1± 0 37。术后病人无并发症 ,心绞痛消失 ,全部治愈出院 ,平均住院 (7 0± 1.5 )d。随访无死亡。结论　OPCAB术吻合口的通畅率令人满意 ,静脉桥血流量高于LIMA ;LAD近段狭窄大于 90 %时LIMA血流量较高。反映桥通畅的最可靠指标是桥血流的搏动指数 ,而舒张期血流的波     

冠状动脉内膜剥脱联合旁路移植治疗弥漫性冠状动脉狭窄病变的近中期效果

目的探讨冠状动脉内膜剥脱术(CE)联合冠状动脉旁路移植术(CABG)治疗弥漫性冠状动脉狭窄病变的近中期效果。方法回顾性分析2010年1月至2019年1月在南京市第一医院心胸血管外科接受CE+CABG的248例弥漫性冠状动脉狭窄病变患者的临床资料。男性201例,女性47例;年龄(65.6±8.5)岁(范围:43~79岁)。体外循环手术156例,非体外循环手术92例。共对269根病变血管完成CE,包括前降支108根,右冠状动脉140根,钝缘支21根。共完成旁路移植872支,包括左胸廓内动脉248支,桡动脉48支,大隐静脉576支,每例患者移植(3.5±0.8)支(范围:2~6支)。CE后平均血流量为(26±8)ml/min(范围:13~59 ml/min),血流指数为3.1±0.8(范围:2.0~6.7)。采用t检验或χ²检验比较体外循环和非体外循环患者的手术结果及术后通畅率。结果全组围手术期病死率为1.2%(3/248),2例死于肾功能衰竭,1例死于术后顽固性低心排血量。9例发生围手术期心肌梗死。随访(41.8±21.4)个月(范围:1~68个月)。旁路血管术后1年通畅率为78.4%(182/232),3年通畅率为69.8%(162/232)。左冠状动脉系统通畅率明显高于右冠状动脉系统(1年:87.4%比73.1%,χ²=6.533,P=0.011;3年:78.2%比64.8%,χ²=4.588,P=0.032)。体外循环组和非体外循环组旁路血管通畅率无差异(1年:80.0%比76.9%,χ²=0.277,P=0.599;3年:71.5%比67.9%,χ²=0.300,P=0.584)。结论CE+CABG治疗弥漫性冠状动脉狭窄病变可以获得较满意的完全再血管化,有较好的早、中期效果和旁路血管通畅率。体外循环和非体外循环手术具有相似的早中期结果。     

再次冠状动脉旁路移植术的临床应用

目的总结再次冠状动脉旁路移植术(CABG)治疗冠心病的临床经验和手术效果。方法2001年6月～2006年12月,对18例冠心病患者行再次CABG。术前心绞痛(CCS分级)级7例,级11例;冠状动脉造影显示:16例均有原移植静脉狭窄/闭塞,2例左乳内动脉(LIMA)-左前降支(LAD)桥狭窄/闭塞,6例自体冠状动脉出现新的病变。全组均经原胸骨正中切口径路手术,常规体外循环(CPB)下CABG15例,非体外循环冠状动脉旁路移植术(OPCAB)3例;同期行室壁瘤切除、左心室成形1例,二尖瓣成形术3例,主动脉瓣和二尖瓣双瓣膜置换联合右颈动脉内膜剥脱术1例。应用LIMA12例次、双侧IMA4例次、桡动脉3例次,其余为大隐静脉或小隐静脉。结果15例常规CABG患者主动脉阻断时间45～112min(57±26min),CPB时间66～140min(78±24min)。再次CABG每例移植血管1～5支,平均每例远端吻合口3.11个。手术结束用血流仪测定移植血管血流量均满意(血流量27.0±12.5ml/min),搏动指数均<4.2。手术后因低心排血量需主动脉内球囊反搏辅助1例,术后6d发生肾功能衰竭死亡。其余17例患者术后呼吸机辅助呼吸时间5～15h,心绞痛均消失,围手术期无心肌梗死发生,胸腔引流量为290～1040ml,顺利恢复,均出院。术后随访17例,随访时间6.0个月～4.5年,均无心绞痛发作,4例复查冠状动脉造影,显示移植血管均通畅。结论再次CABG难度大于首次CABG,但只要手术中能正确找到靶血管,移植血管的血流可靠、完全再血管化和有良好的围术期管理,再次CABG可达到与首次手术同样的效果。     

冠状动脉旁路移植术后移植血管通畅率的影响因素分析

目的分析冠状动脉旁路移植术(CABG)后1年移植血管通畅率及危险因素。方法前瞻性连续纳入哈尔滨医科大学附属第一医院2010年6～12月行CABG患者71例,其中男37例,女34例;年龄(59.8±7.7)岁,由同一术者主刀完成手术,术后用标准药物治疗。术后1年行冠状动脉256排多层螺旋CT检查,根据移植血管通畅与否,将患者分为闭塞组(n=16)和通畅组(n=55)。收集术前、术中和术后随访资料,通过单因素分析和logistic多因素回归分析筛选导致移植血管病变的危险因素。结果术后1年移植血管通畅率为91.0%(172/189)。单因素分析结果显示,术前胆固醇水平(t=-2.389,P=0.017)、血管弥漫性病变(χ2=4.449,P=0.042)、靶血管直径(t=5.064,P=0.000)、术后未规范服用抗血小板药物(χ2=10.175,P=0.008)是移植血管病变的潜在危险因素。logistic多因素回归分析结果显示,靶血管狭窄[RR=0.014,95%CI(0.001,0.228),P=0.003]和术后未规范服用抗血小板药物[RR=13.375,95%CI(1.075,175.536),P=0.044]是移植血管病变危险因素。结论 CABG患者术后1年移植血管通畅率较高,移植血管通畅率与靶血管狭窄及术后抗血小板药物的规范服用相关。     

冠状动脉旁路移植术中应用右侧乳内动脉的单中心研究

目的总结冠状动脉旁路移植术(CABG)中右侧乳内动脉(RIMA)的使用情况, 分析RIMA使用的目的、方式和结果。方法回顾性收集2016年1月1日至2021年10月31日期间在北京大学人民医院心外科行CABG术患者的临床资料, 按是否应用RIMA分为RIMA组和非RIMA组, 对两组患者按1∶1行倾向性匹配, 比较手术结果, 分析RIMA应用情况。结果共完成CABG术1 537例, 其中128例应用RIMA。经倾向性评分匹配后, RIMA组(128例)与非RIMA组(128例)患者的基线数据差异无统计学意义(P>0.05)。RIMA组旁路移植血管数[(2.81±0.91)支/例对(2.40±1.26)支/例, P=0.005]和动脉旁路移植血管数[(2.10±0.65)支/例对(0.99±0.43)支/例, P<0.001]均高于非RIMA组, 静脉旁路血管移植数少于非RIMA组[(0.71±0.90)支/例对(1.41±1.35)支/例, P<0.001]。RIMA组术后胸腔引流量多于非RIMA组[(1 068.45±494.02)ml对(888.02±422.67...     

定量血流分数指导冠状动脉外科血运重建手术策略的研究

目的探讨术前应用定量血流分数(QFR)评估冠状动脉功能性狭窄程度, 指导冠状动脉旁路移植(CABG)血运重建策略的可行性。方法前瞻性纳入2019年1月至2020年9月期间在北京安贞医院心脏外科十一病房择期行单纯CABG的154例患者, 对冠状动脉造影目测提示狭窄的病变血管进行QFR分析, 获得病变血管功能性狭窄情况, 外科医师术前对QFR分析结果不知情。收集患者基线资料、围手术期相关数据及近期临床结局并总结分析。结果 1年后冠状动脉CTA显示, 功能性显著病变(QFR<0.8)血管的旁路移植血管闭塞率为5.5%, 非功能性显著病变(QFR≥0.8)血管的旁路移植血管闭塞率为15.6%。随访发现, 心绞痛分级在发生与未发生旁路移植血管闭塞的患者间差异无统计学意义。结论依据QFR分析的功能性非显著病变的冠状动脉发生旁路移植血管闭塞的风险高于功能性显著病变血管, 对于QFR提示阴性病变的冠状动脉, 动脉旁路移植血管发生闭塞的风险比静脉旁路移植血管更高。这一发现与临床预后并无明显关联, 非显著病变血管的旁路移植血管通畅或闭塞的患者均未发现过多心绞痛发作或冠状动脉重复干预的情况。QFR指导...     

64排CT对冠状动脉旁路移植术后桥血管病变的诊断研究

目的 评价64排螺旋CT血管造影(MSCTA)对冠状动脉旁路移植术(CABG)术后桥血管病变诊断的准确性.方法 2005年7月至2007年4月,共228例患者于CABG术后复查64-MSCTA,其中31例患者(82支桥血管)因有心绞痛或CT结果提示桥血管损害,进一步行冠状动脉造影(CAG).结果 所有桥血管均获得评价.64-MSCTA共发现13支桥血管闭塞,均得到CAG证实.CAG发现15支桥血管严重狭窄,64-MSCTA发现14处,漏诊1处,误诊1处.64-MSCTA诊断冠状动脉桥狭窄的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为93.3%、98.1%、93.3%、98.1%和97.1%;诊断桥血管病变的灵敏度、特异度、阳性预测值、阴性预测值和与CAG符合率分别为96.4%、98.1%、96.4%、98.1%和97.6%.结论 64-MSCTA可以准确评价术后桥血管通畅情况.     

70岁以上患者的冠状动脉旁路移植术

目的介绍70岁以上高龄患者行冠状动脉旁路移植术(CABG)的结果和围术期处理策略. 方法对70岁以上患者行CABG 121例,119例(98.3%)为不稳定型心绞痛,113例(93.4%)合并其他疾病.80例(66.1%)采用非体外循环心脏不停跳CABG(OPCAB),41例(33.9%)选择常规体外循环CABG(CCABG);胸膜外技术游离左乳内动脉(LIMA),保持胸膜腔完整,常规将LIMA与左前降支(LAD)吻合,其余桥用大隐静脉(SV).术中使用即时超声血流仪(TTFM)测量移植血管血流,保证吻合口通畅.术后加强物理治疗和营养支持,严格控制血糖于6～10 mmol/L.结果行CCABG患者移植血管3.08±0.75支, OPCAB患者2.24±0.82支,110例(90.9%)使用LIMA.全组死亡1例(急诊手术),死亡率0.8%,死于多器官功能衰竭;发生并发症4例(3.3%).术后呼吸机使用时间OPCAB患者10.04±5.68小时,CCABG患者21.46±14.54小时;住ICU 时间2.65±1.45天,术后12.22±5.56天出院. 结论充分评估手术风险,选择恰当的手术方案,经过缜密的围术期处理,高龄患者亦可取得良好的手术效果.     

225例左主干狭窄冠状动脉旁路移植术

目的 总结冠状动脉左主干狭窄(LMS)的外科治疗效果和临床经验。方法1999年1月至2003年6月，225例LMS病人接受了冠状动脉旁路移植术(CABG)。平均年龄63．4岁。左室射血分数(LVEF)≤0．3011例。6例急诊手术，其中3例术前放置主动脉球囊反搏(IABP)。76例在常规体外循环下手术；149例应用非体外循环不停跳技术，术中改为体外循环5例。其中13例全动脉化、3例全静脉化旁路移植术。结果平均术前住院2．3d。平均每例远端吻合口2．95个。死亡13例(5．78％)。结论尽管LMS是预示CABG术后死亡率的独立危险因素，但CABG现在仍是其治疗的第一选择，且是安全、有效的方法。     

1110例冠状动脉搭桥术的早期结果

目的　回顾性总结１９９６ 年１ 月以来１１１０ 例冠状动脉搭桥术（ＣＡＢＧ） 的近期疗效,介绍冠心病搭桥术的体会和经验。　方法　体外循环下行ＣＡＢＧ１０４８ 例,非体外循环ＣＡＢＧ６０ 例。心肌保护均采用冷血含钾停跳液,体外循环时间１１５ ±３５ 分钟,主动脉阻断时间７２ ±２４ 分钟,单支搭桥１１０ 例,２ 支搭桥１４５ 例,３ 支搭桥４１５ 例（３７－３ ％） ,４ 支搭桥或４ 支以上４３９ 例（３９－５％） 。搭桥材料：左乳内动脉７５１ 例,大隐静脉８７７ 例,桡动脉１０１ 例,全动脉化７２ 例。合并手术：室壁瘤切除１１２ 例,室壁瘤折叠１４ 例,左室成形５ 例,瓣膜手术４８ 例,室间隔穿孔修补术５ 例。　结果　住院死亡９ 例,死亡率０－８１％ 。其余患者痊愈出院,心绞痛基本缓解。术后并发症：低心排１１ 例,主动脉球囊反搏７例,围术期心肌梗塞２ 例,脑部并发症３ 例,二次开胸止血４ 例。　结论　选择好靶血管和充分血管化是冠状动脉搭桥术的关键。另外要重视围术期处理。     

1198例非体外循环冠状动脉旁路移植术的早期临床分析

目的　总结分析非体外循环冠状动脉旁路移植术 (OPCAB)的早期临床结果和经验体会。方法　 1996年 10月至 2 0 0 2年 5月在国内 15个冠心病微创外科中心完成非体外循环冠状动脉旁路移植术 1198例 ,占同期冠心病手术的 79 5 % ,OPCAB实施率 (即OPCAB占单纯冠状动脉旁路移植术的百分比 )为 85 2 %。年龄平均 (6 1 6± 9 0 )岁 ,男性占 77 3%。 18 7%为左主干病变 ,76 9%为 3支病变。左心室射血分数平均 0 5 6± 0 17。其中二次手术者占 1 5 % ,急诊手术占 9 9%。结果　 2 2例为小切口单支病变旁路移植手术 ,其余均为正中切口、多支病变的OPCAB手术。远端吻合口为 (3 1± 0 9)个 ,乳内动脉桥占 6 5 6 % ,桡动脉桥占 18 0 % ;5 2 %病人使用主动脉内球囊反搏。住院死亡 14例 ,病死率 1 2 %。其中术后心跳骤停或室颤 7例 ,大出血 2例 ,昏迷伴肾功能衰竭 2例 ,大面积脑梗塞 2例 ,呼吸衰竭 1例。并发症中 ,围术期心肌梗死占 0 4% ,急性左心功能衰竭占 0 3% ,严重心律失常占 1 2 % ,呼吸系统并发症占 2 0 % ,器质性神经系统并发症占 1 2 % ,新发或加重的肾功能不全占 0 7% ,出血二次开胸占1 0 % ,胸骨愈合不良占 0 6 %。结论　OPCAB手术安全可行 ,早期效果满意 ,远期效果有待进一步观察。OPCAB具备一     

Association of plasma osteopontin levels with coronary calcification evaluated by tomographic coronary calcium scoring

Evidence indicates that proteins controlling bone mineralization are also involved in the regulation of coronary calcification. The aim of the present study is to evaluate the association between plasma osteopontin (OPN) levels and coronary calcification quantified by using tomographic coronary calcium scoring. Plasma OPN levels were measured from samples of 80 intermediate-risk asymptomatic patients (56 ± 10 years) who underwent tomographic coronary calcium scoring via multislice computed tomography for incremental risk stratification. There was no significant difference regarding OPN levels between patients with and without coronary calcification in the whole study population. Of 49 patients not receiving renin–angiotensin system inhibitors and/or statins, plasma OPN levels of patients with coronary calcification (38.7%) were significantly higher than those without coronary calcification (61.3%) (8.88 ± 2.85 vs. 6.79 ± 2.41, P = 0.008, respectively). On a binary logistic regression model, only age and plasma OPN level were found to be significant independent associated variables for the presence of coronary calcification in patients not receiving these medications (odds ratio for age, 1.15, P = 0.017; for plasma OPN levels, 1.63, P = 0.014). Our results indicate that plasma OPN levels may be predictive of coronary calcification, suggesting an important role of OPN in the atherosclerotic calcification pathogenesis.     

Morphologic expression of the left coronary artery in pigs. An approach in relation to human heart

Introduction

In spite of its importance as an experimental model, the information on the left coronary artery in pigs is sparse.

Objective

To determine the morphologic features of the left coronary artery in pigs.

Methods

We evaluated 158 pig hearts. The left coronary artery was perfused with synthetic resin after their ostia had been catheterized. Diameters and courses of the vascular beds were measured with an electronic caliper (Mitutoyo^®).

Results

The diameter of left coronary artery was 6.98 ± 1.56 mm and its length was 3.51±0.99 mm. It was found to end up by bifurcating itself into the anterior interventricular artery and the circumflex artery in 79% of the cases, and by trifurcating in 21% of the cases, with the presence of the diagonal artery. The anterior interventricular artery ended up at the apex in 79.7% of the cases, and the circumflex artery at the posterior aspect of the left ventricle in 64% of the case, this artery never reached the posterior interventricular sulcus. An anastomosis between the terminal branches of the anterior interventricular artery and the posterior interventricular artery was found in 7.6% of the specimens. The antero-superior branch of the anterior interventricular artery occurred in 89.9% of the hearts. A left marginal branch was observed in 87.9% of the cases with a diameter of 2.25±0.55 mm.

Conclusion

Compared with humans, pigs have shorter left coronary artery trunks and branches; even the circumflex artery never reaches the posterior interventricular sulcus. Our findings are useful for the design of experimental hemodynamic and procedural models.     

Normal coronary artery dimensions in Indians

Background There is no available data on normal coronary artery size in the Indian population. We attempted to establish a database for normal dimensions of the coronary artery segments during life by using quantitative coronary angiography and compared these with Western estimates of coronary artery size. Material and Methods Between december 2003 and June 2004, 94 patients who underwent quantitative coronary angiography for evaluation of symptoms of ischemic heart disease and were found to have no coronary artery disease form the sample size. Results The dimensions of branches in the left coronary system in our patients were less and those of the distal circumflex, and the proximal and distal left anterior descending coronary arteries were significantly greater than those of Indian Asians living in the United Kingdom and the native Caucasians but the dimensions of the right coronary artery were significantly greater in our patients. Conclusions Coronary artery dimensions for at least some branches of the left coronary system are similar to that reported in the West and the dimensions of the right coronary are greater. These findings contradict the general perception that Indians have smaller coronary arteries.     

Intensive Use of Intravascular Ultrasound during Coronary Angioplasty. A Six-month Campaign

Background - Compared to coronary angiography, intravascular ultrasound (IVUS) gives additional information important for the percutaneous transluminal coronary angioplasty (PTCA) procedure, but is time-consuming and may cause complications. Aim - To evaluate, during a period of intensive use of IVUS, the impact of IVUS on the final decision on balloon/stent diameter, consumption of devices, time-consumption and IVUS-related complications. Method - During a 6-month period, IVUS was contemplated in all PTCA procedures and the reason for not using IVUS was specified. We used CVIS during the first, and Endosonics during the last 3 months, and both periods started with 1 week of hands-on practice. All procedures were to be planned according to an initial quantitative coronary angiography (QCA), and the finally achieved result, material used and complications were registered. Results - The proportion of IVUS/PTCA was 37% during, 8% 6 months before and 12% 6 months after the study period. Three hundred and twenty-three patients were included in the study (57% of all patients), 199 of them were subjected to IVUS. The indications for PTCA during the study period were stable angina (58%), unstable angina (32%) and acute myocardial infarction (10%). The main reasons for not doing IVUS were use of 6F guiding catheter (13%), urgent procedure (12%) and occluded vessel (11%). Initial QCA detected 253 stenoses in 199 patients and 64 additional stenoses were treated, most of them probably detected by IVUS. QCA systematically underestimated vessel size, particularly in small vessels. There was a non-significant trend to more accurate estimations towards the end of the study in small vessels. Dissection, probably due to IVUS, occurred in two cases (1%). There were no significant differences in the number of devices used in IVUS compared to non-IVUS patients. The procedural time was 24 min longer in IVUS than in non-IVUS cases and more stenoses were treated per procedure in the IVUS group. Conclusion - Coronary angiography often underestimated balloon/stent size but in an unpredictable way, with a substantial proportion of significant stenoses being undetected. IVUS had few serious complications, did not increase device consumption but prolonged procedural time.     

全动脉化冠状动脉搭桥的临床应用

目的 介绍全动脉移植物行冠状动脉搭桥的早期效果和临床经验。方法 采用全动脉移植物87例冠心病患者实施冠状动脉搭桥。其中男性患者82例,女性5例;单支冠状动脉病变14例,2支病变19例,3支病变54例。62例患者术前有心肌梗死,7例合并室壁瘤,1例合并主动脉瓣关闭不全。71例患者在体外循环下行冠状动脉搭桥术,16例在非体外循环下行冠状动脉搭桥术。同时行室壁瘤切除术7例,行主动脉瓣替换1例,行冠状动脉内膜剥脱2例。应用左乳内动脉84例次,右乳内动脉46例次,胃 网膜右动脉37例次,左桡动脉51例次。单个远端吻合14例,2个19例,3个50例,4个4例。结果 围手术期死亡2例（病死率2．3％）,1例为围手术期心肌梗死低心排,1例为顽固性心律失常。3例术后发生胸骨裂开切口感染,再次清创处理后痊愈。本组患者随访1．0－30．0个月（平均13．2个月）,1例患者因突发脑血管意外在术后40d死亡,其余患者术后均恢复良好,无心绞痛症状再发。B超检查乳内动脉移植血管均通畅。结论 全动脉化冠状动脉搭桥具有良好的临床应用效果,尤其适合于年轻的冠心病患者。     

再次冠状动脉旁路移植术42例临床分析

目的 总结再次冠状动脉旁路移植术(CABG)的临床特点及手术效果.方法 对2002年1月至2010年12月连续收治的42例CABG术后患者行再次CABG.其中男性29例,女性13例;年龄46～78岁,平均(61.2±2.1)岁.非体外循环CABG患者31例,心肺转流下CABG患者11例,同期分别行主动脉瓣置换术及主动脉根部替换+右半主动脉弓置换术各1例.结果 全组死亡3例,1例因术中右心室破裂死亡,1例因术后心力衰竭死亡,1例发生肾功能衰竭导致多器官功能衰竭死亡,围手术期病死率为4.8%.其余40例术后呼吸机辅助呼吸时间9～27 h,平均(17±7)h.术后心绞痛均消失,围手术期无心肌梗死发生,顺利恢复出院.术中接受主动脉内球囊反搏6例.术后随访38例,随访时间6～54个月,均无心绞痛发作;12例复查冠状动脉CTA,显示移植血管均通畅.结论 随着手术技巧和围手术期管理的改进,合理采用各种技术,再次冠状动脉旁路移植术可以取得满意疗效.

Abstract：

Objective To determine the clinical characteristics and outcomes of redo CABG.Methods The outcomes of 42 consecutive patients who underwent redo CABG from January 2002 to December 2010 was analyzed.There were 29 males and 13 females,aging from 46 to 78 years old with a mean of(61.2 ± 2.1)years.Off-pump CABG was applied for 31 patients and on-pump CABG for 11 patients.There were 1 patient underwent concomitant aortic valve replacement and 1 patient underwent aortic root and right aortic arch replacement respectively.Results Three patients died of right ventricle rupture,heart failure and multiple system organ failure respectively and the perioperative mortality rate was 4.8%.The post-operatively mechanical ventilation time varied from 9 to 27 h with a mean of(17 ±7)h.There was no residual angina and perioperative myocardial infarction in the remaining patients who were all discharged uneventfully.Intraoperative 6 patients had accepted intraaortic balloon counterpulsation.During the followup from 6 months to 4.5 years for 38 patients,which showed no evidence of recurrent angina and postoperative coronary CT angiography in 12 patients showed the patency of grafts is good.Conclusion Satisfactory outcome of redo coronary artery bypass grafting can be achieved if proper indication were choosed and reasonable management were performed.