心脏退行性瓣膜病合并冠心病同期手术治疗

目的:总结老年退行性瓣膜手术和冠状动脉旁路移植术(CABG)同期施行的效果和临床经验。方法:2011年1月-2012年12月同期行退行性瓣膜手术与冠状动脉旁路移植术的老年患者63例,其中男37例,女26例,年龄60～72岁,平均年龄(65±4)岁。退行性瓣膜疾病合并冠心病42例,冠心病合并退行性瓣膜病21例。同期行冠状动脉旁路移植术合并瓣膜置换58例,其中双瓣膜置换5例,合并三尖瓣成形术15例,合并带瓣人工血管置换(Bentall)手术1例,合并室壁瘤切除术1例,合并左房血栓清除术2例;合并单瓣膜成形术7例。冠状动脉造影显示单支血管病变15例,双支16例,多支32例。结果:本组早期病死3例(4.8%),共出现并发症8例(12.7%);患者中2例死于重症感染引发的多器官功能衰竭,1例死于低心排综合征。低心排综合征2例,再次开胸止血3例,呼吸衰竭2例,室颤1例,脑栓塞2例均治愈。手术后随访43例,随访时间1～60个月,随访期间无死亡,患者生活质量明显改善。结论:老年患者退行性瓣膜手术及冠状动脉旁路移植术同期施行手术效果满意,具有安全可行性。

Old Degenerative Valvular Disease Merge the Surgical Treatment of Coronary Artery Disease

Objective:To summarize old degenerative valvular surgery and coronary artery bypass graft(CABG) surgery and the effect and clinical experience.Methods:January 2011 to December 2012 line the degenerative valvular surgery and coronary artery bypass graft(CABG) surgery in 63 cases of elderly patients,including male and female patients,26 cases,aged 60 to 72 years old,average age(65±4) degenerative valvular disease merger coronary heart disease,coronary heart disease combined 42 patients with degenerative valvular disease from 21 cases do coronary artery bypass graft(CABG) surgery combined valve replacement and patients with double valve replacement 5 cases,combined with tricuspid valve plasty 15 cases,combined with artificial blood vessel with disc replacement(Bentall) surgery 1 case,combined with Ventricular aneurysm resection in 1 merge left atrial thrombus removal technique in 2 cases,combined single valvuloplasty 7 cases of coronary artery angiography showed single vascular lesions in 15 cases,double branch in 16 cases,have 32 cases.Results:The early ill in 3 patients(4.8%),common complications eight patients(12.7%);patients in 2 cases died of severe infection of multiple organ failure,and 1 case died of low cardiac output low cardiac output in 2 cases,once again open chest hemostatic 3 cases,2 cases of respiratory failure,ventricular fibrillation 1 cases were cured;follow-up after surgery 43 cases,follow-up of 1~60 months follow-up period,no death,patients quality of life improved obviously.Conclusion:Elderly patients with degenerative valvular surgery and coronary bypass surgery during the same period with satisfactory effect,have safety feasibility.