冠状动脉旁路移植术同期行瓣膜手术临床分析

目的总结在冠状动脉旁路移植术同期行心脏瓣膜手术的临床经验。方法30例患者在冠状动脉旁路移植术同期进行瓣膜手术，年龄40-76（62．9±10．4）岁。其中缺血性瓣膜病变22例，风湿性瓣膜病变8例。术前冠状动脉造影诊断26例，术中发现冠脉严重病变4例。全组共移植血管133支（平均4．43支）。同期行主动脉瓣置换术3例、二尖瓣置换术12例、二尖瓣成形术8例、双瓣膜手术7例。结果术后住院死亡1例（3．3％），死于严重低心排血量。术后心功能Ⅰ级22例、Ⅱ级7例，均较术前明显改善。结论同期行冠状动脉旁路移植术和瓣膜手术安全、有效。冠心病与心脏瓣膜病同时存在明显加重了心肌损害，完善纠治瓣膜病变、充分心肌再血管化和严格的术中心肌保护是手术成功的关键。

Clinical analysis of combined valve procedures and coronary artery bypass grafting

Objective To evaluate the clinical features and outcomes of concomitant valve operations and coronary artery by pass grafting （CABG）. Methods 30 patients underwent the combined valve operations and CABG, with the mean age of 62.9±10.4 years （range 40-76 years）. Valvular pathology was included 8 rheumatics, 22 nonrheumatic lesions. 26 cases were found severe coronary stenosis by arteriography preoperatively and 4 patients were identified intraoperatively. Left ventricular ejection fraction was 50% or less in 7 patients. The total number of bypass grafts was 133 with a mean graft of 4.43 per patient. Valve procedures included： 3 aortic valve replacement, 12 mitral valve replacement, 8 mitral valvuloplasty, 7 mitral valve and aortic valve procedures. Results There were 1 postoperative death with the mortality of 3.3% due to low cardiac output syndrome within 30 postoperative days. All survivors were free of angina. Conclusion Good results can be achieved in patients with combined CABG and valve operation. Complete repair the valve lesion and complete revascularization and carefully intraoperative myocardial protection contribute to the success result.