冠状动脉旁路移植术应用于介入治疗后血管再狭窄患者

目的：总结分析76例介入治疗后患者行冠状动脉旁路移植术(coronary artery bypass grafting，CABG)的经验体会。方法：1999年8月至2002年4月共完成介入治疗后的CABG手术76例，占同期CABG手术的14.0％。单纯经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty，PTCA)39例，合并支架置人术37例，合并斑块旋切术2例，二次介入治疗史5例。介入治疗相关血管再狭窄46例，新产生的其他冠脉病变6例，介入治疗不成功者4例，介入治疗后残留严重血管病变11例，介入治疗急性并发症9例。介入治疗组心肌梗死患者的比例高于非介入治疗组，而三支病变患者的比例低于非介入治疗组。结果：介入治疗组急诊手术比例为27．6％，高于非介入治疗组的13．3％，而OPCAB实施率为91．3％，低于非介入治疗组的97．2％。介入治疗组远端吻合口数目少于非介入治疗组。介入治疗组手术死亡6例，其中3例死于泵衰竭，1例死于心室纤颤，1例死于脑部并发症，1例死于肾功能衰竭，其手术死亡率(7．9％)高于非介入治疗组(1．9％)。介入治疗组发生围术期心梗4例(5．3％)，其发生率高于非介入治疗。随访远期死亡1例，复发心绞痛1例。结论：对于介入治疗后再狭窄、不能达到完全再血管化和引起急性并发症的患者，冠状动脉旁路移植术常常是最为有效而必要的治疗方法。及时合理地处理介入治疗急性并发症，是降低死亡率的主要措施。

Coronary artery bypass grafting in patients following percutaneous coronary interventions

Objective: To investigate and analyze the clinical outcomes of coronary artery bypass grafting (CABG) in patients with history of previous percutaneous coronary interventions (PCI). Methods: We studied 76 patients with a history of PCI who underwent CABG surgery in our institute from August of 1999 to April of 2002, which was 14.0 percent of concurrent CABG. There were 39 cases with PTCA alone and 37 combined with stent implantation, of whom 5 had undergone re do PCI therapy. Then 46 patients encountered re stenosis and 6 developed new lesion in native coronary arteries. There were 4 cases with unsuccessful PCI, 11 cases with residual lesion in important vessels and 9 cases with acute complications during PCI. There was a higher incidence of myocardial infarction in group PCI than that in group Non PCI, and a lower incidence of triple vessel disease ( P <0.01). Results: Group PCI had more emergent surgeries (27.6% vs 13.3%) and fewer OPCAB procedures (91.3% vs 97.2%) than group Non PCI ( P <0.01). The mean number of distal anastomosis in group PCI was smaller than that in group Non PCI ( P <0.01). There were 6 people who died in group PCI, of whom 3 died of heart pump failure,1 of ventricular fibrillation, 1 of neurological complication, and 1 of renal failure. The mortality of group PCI was higher than group Non PCI (7.9% vs 1.9%, P <0.01). In group PCI, there were 4 with peri operative myocardial infarction, 1 with late death and 1 with recurrent angina pectoris. Conclusion: CABG is usually the most effective and necessary way to treat PCI failure, unsatisfactory revascularization and its acute complications. It is most important to promptly and appropriately deal with acute complications of PCI in reducing the mortality.