左主干行冠状动脉旁路移植手术中远期效果分析

目的 总结2002~2008年行冠状动脉旁路移植手术的冠心病左主干患者远期桥血管通畅率。 方法 2002~2008年冠心病左主干患者行冠状动脉旁路移植术共73例,男性57例,女性16例,患者年龄65.7±8.1岁。包括心肌梗死31例、左心室室壁瘤11例,合并瓣膜病变4例,术前使用主动脉气囊反搏(IABP)5例。行急诊冠状动脉旁路移植术共5例,冠状动脉旁路移植术+瓣膜置换术共4例,冠状动脉旁路移植术+室壁瘤切除并左心室成形术共6例,机器人冠状动脉旁路移植术1例。其中体外循环下手术65例,非体外循环手术8例。左乳内动脉与左前降支吻合,大隐静脉与靶血管吻合,静脉吻合口超过两个(含)时做序贯吻合。术后随访行冠状动脉64-CT或冠状动脉造影复查桥血管通畅率。 结果 术后死亡2例(病死率2.7%),死因分别为恶性心律失常和多器官衰竭。痊愈出院71例,随访患者53例,失访18例,随访率74.6%,随访时间4个月~11年,平均随访时间73.2±30.2个月。随访期间死亡8例,其中3例为心源性死亡,心源性病死率5.7%,余者为其他疾病死亡。10例再发心绞痛,2例心肌梗死,2例脑梗死。 39例患者行桥血管CT或造影,动脉桥通畅率97.4%,静脉桥通畅率82.8%。 结论 冠心病左主干患者病情重,行冠状动脉旁路移植术可有效改善冠脉血运,远期效果良好。

A Mid to Long Term Results of Patients with Left Main Disease Undergoing Coronary Artery Bypass Grafting

Objective To summary the long-term graft patency and the follow-up outcome of coronary artery bypass grafting in left main disease. Methods Seventy three patients received CABG including 57 male and 16 female patients with a mean age of 65.7±8.1 years. Indications for the patients included myocardial infarction (31 cases), left ventricular aneurysm(11 cases), valve disease(4 cases). Five patients were preoperatively supported by intra-aortic balloon pumping (IABP). 5 patients received emergency coronary artery bypass grafting (ECABG). Four patients were with valve replacement, Five patients were with left ventricular aneurysm operation,and 1 patient were with totally endoscopic coronary artery bypass (TECAB). Sixty five on-pump operation were performed and 8 patients received off-pump surgery. The left internal mammary artery(LIMA) was routinely anastomosed to left anterior descending arter (LAD) and great saphenous vein (GSV) to other target vessels in a segmental or sequential anastomosis. The graft patency was evaluated by 64-CT scan or angiography. Results two patients died of arrhythmia and multiple organ failure after surgery respectively. The left 71 patients were discharged. 53 patients received follow-up successfully. The follow-up rate was 74.6%. The follow-up period ranged from 4 month to 11 year with a mean time of 73.2±30.2 month. Eight patients died during follow-up period. Three of them were cardiac death. The other 5 were died of non-cardiac disease. Ten patients had recurrence of angina. Two patients had myocardial infarction. 2 patients had cerebral infarction. Thirty nine patients received 64-CT or angiography. The LIMA-LAD patency was 97.4%, and the GSV graft patency was 82.8%. Conclusion Proper indication and timing for LM disease were essential for optimal results. CABG was safe and efficacious for patients suffered from LM disease. The mid to long-term results were satisfied.