冠状动脉搭桥和心脏瓣膜手术同期施行的应用冠状动脉搭桥和心脏瓣膜手术同期施行的应用

目的总结同期施行冠状动脉搭桥和心脏瓣膜手术的早期效果和经验。方法23例病人中16例为风湿性心脏瓣膜病合并冠状动脉病变，7例为冠心病合并心脏瓣膜功能不全。冠状动脉单支病变13例，其余为多支病变。23例均在全麻体外循环下同期施行冠状动脉搭桥和心脏瓣膜手术，同期室壁瘤手术3例，瓣膜置换24个，瓣膜成形6例次，人均搭桥1．74支。手术后低心排2例需主动脉内球囊反搏支持。结果23例病人取得了良好的临床效果，无手术死亡，心脏功能得到明显改善。结论同期施行冠状动脉搭桥和心脏瓣膜手术是有效可行的，近期效果满意。

Experience

Objective　To　retrospectively　review　the　experience　of　combined　valvular　and　myocardial　revascularization　operation．Methods　Combined　valvular　and　myocardial　revascularization　operation　was　performed　on　23　patients，　of　whom　16　patients　had　rheumatic　heart　disease　with　coronary　stenosis，and　7　patients　had　coronary　disease　with　valvular　dysfunction．　Single　vessel　disease　was　in　13　patients　and　the　others　were　multi-vessel　disease．　All　the　patients　received　combined　valvular　and　myocardial　revascularization　operations　under　cardiopulmonary　bypass．21　mechanical　valves　and　3　tissue　valves　were　used　and　valvular　plasty　was　done　on　5　patients．The　average　number　of　grafts　were　1．74．　Post-operative　intra-aortic　balloon　pump　was　required　in　2　cases　for　low　cardiac　output　syndrome．Results　There　was　no　operative　mortality　in　this　group．All　patients　recovered　and　were　discharged　with　improved　heart　function．There　were　2　late　deaths　in　a　mean　follow-up　period　of　9．4　months　because　of　stroke．Conclusion　Combinde　valvular　and　myocardial　revascularization　operations　is　effective　with　acceptable　morbidity　and　mortality　rates．