胸主动脉瘤合并冠心病同期外科治疗(附15例报告)

目的 总结胸主动脉手术同期行冠状动脉旁路移植术的经验。方法1999年6月至2002年7月，胸主动脉瘤手术同期行冠状动脉旁路移植术15例，均为男性；年龄40～66岁，平均57．2岁；体重60～89kg，平均70．2kg。病种包括主动脉根部瘤5例、升主动脉瘤2例、弓部瘤3例、主动脉夹层5例。经胸骨正中切口在全麻低温体外循环下手术14例；左外侧切口非体外循环下冠状动脉旁路移植同期股股转流降主动脉置换术1例。结果术后早期30d内死亡1例，随访1～36个月，无远期死亡，无再次手术及冠心病相关事件发生。结论胸主动脉置换术与冠状动脉旁路移植术能够安全同期进行，同期冠心病的再血管化对预防冠心病相关事件的发生有积极作用。

Surgical management of thoracic aortic aneurysm combined with coronary artery disease

Objective: To review the experience of one-stage surgical management of thoracic aortic aneurysm associated with coronary artery disease. Methods: From June 1999 to July 2002, fifteen patients (all the male, average age 57.21 year-old, ranged 40-66 year-old) underwent thoracic aortic aneurysm repair and concomitant coronary revascularization. The diagnosis are aortic root aneurysm in 5 cases,ascending aortic aneurysm in 2,arch aortic aneurysm in 3,and aortic dissecting in 5. 14 patients received operation through midsternotomy,including ascending aorta replacement in 2, Bentall technique in 4, David technique in 1 and total arch replacements in 3 patients. Left thoracotomy and off-pump CABG was done in 1 case. Results: 1 patient died in 30 days after operation. Followed up for a mean duration of 17 months,there were no late death and no reoperation and no related events occurred. Conclusion: Thoracic aortic replacement and CABG (coronary artery bypass grafting) could be done at one-stage. Concomitant coronary revascularization may aggressively obviate CAD events.