老年患者原位乳内动脉行冠状动脉旁路移植术112例

目的　乳内动脉 (IMA)是当前国际上公认的最好的搭桥移植物 ,而在老年患者中使用较少 ,因为人们觉得IMA的使用会增加手术并发症发生率和死亡率 ,而且亚洲人比欧美人IMA细小 ,手术有一定难度 ,据此事实 ,作者总结了老年患者常规使用IMA搭桥的近中期效果、技术要点及手术指征。方法　自 1 997年 4月至 1 999年 9月 ,冠心病 1 68例接受了冠状动脉旁路移植术 (CABG)治疗 ,其中老年患者 1 1 2例 (男 1 1 0例 ,女 2例 ) ,年龄 60～ 75岁 ,平均 66 .5岁。原位IMA使用率占单纯CABG手术的 92 % ,同时行双瓣置换 2例 ,单瓣置换 8例 ,室壁瘤切除、左室成形 1 0例。结果　 1 1 1例痊愈出院 ,心绞痛消失 ,围手术期发生心肌梗死 1例 ,术后死亡 1例。近中期随访效果满意。结论　老年冠心病患者搭桥也应首选IMA ,而且可以常规使用

Internal mammary artery for coronary artery bypass grafting in 112 elderly patients

Objective Use of the left internal mammary artery (LIMA) as a bypass graft has been shown to result in good long term patency and improved survival. In elderly patients, the LIMA has been used rarely for coronary artery bypass grafts (CABG) because of the belief that increased morbidity and mortality are associated with this procedure and, moreover, Asian has smaller LIMA than that of the Westerner. The present paper is to summarize the results and surgical techniques of routine use of in situ LIMA grafting for CABG in Chinese elderly patients. Methods From April of 1997 through September of 1999, 168 consecutive patients had CABG performed. Of them 112, 110 males and 2 females, were elderly (70%) with ages ranging from 60 to 75 years (mean 66.5 years). The rate of utilization of in situ LIMA accounted for 92% of isolated CABG. Concomitant procedures such as aortic or/and mitral valve replacement, left ventricular aneurysmectomy and reconstruction were carried out. Results 111 patients recovered and were discharged. One patient had perioperative myocardial infarction and one patient died of allergy to protamine. The hospital mortality rate was 0.8%. The follow up showed that all the survivors were free of angina and cardiac function improved significantly. Conclusion With the limited number of cases, we conclude that the LIMA is the bypass graft of choice and can be routinely used in Chinese elderly patients.