冠状动脉旁路移植与同期心脏瓣膜置换

背景：心脏瓣膜置换或成形同期行冠状动脉旁路移植手术的选择已成为目前治疗冠状动脉粥样化性心脏病合并心脏瓣膜病的发展趋势。目的：回顾性总结51例心脏瓣膜替换或成形同时行冠状动脉旁路移植手术的经验。方法：回顾性分析同期施行心脏瓣膜置换或成形及冠状动脉旁路移植患者51例临床资料，共移植旁路血管109支，同时行主动脉瓣置换10例，二尖瓣置换14例，二尖瓣置换联合三尖瓣成形8例，主动脉瓣联合二尖瓣双瓣置换4例，主动脉瓣、二尖瓣双瓣联合三尖瓣成形3例，二尖瓣成形7例，二尖瓣成形联合三尖瓣成形5例。结果与结论：置换生物瓣膜者9例，机械瓣膜者31例，二尖瓣成形11例，三尖瓣成形16例；共移植旁路血管109支，冠状动脉旁路移植平均搭桥（1.92±0.73）支；术后30 d内死亡4例。47例顺利出院，其中2例失访，45例随访3-48个月，1例半年后脑梗死，1例于术后1年多死于心脏功能不全，存活的43例心功能改善明显，均可进行一般的生活与活动。综合分析得出彻底解除瓣膜病变，充分保障心肌再血管化，保护心肌，尽量缩短主动脉阻断时间是手术成功的关键因素。

Concomitant cardiac valve replacement and coronary artery bypass grafting

BACKGROUND：Heart valve surgery combined with coronary artery bypass grafting has been gradual y used for treatment of coronary heart disease combined with cardiac valve disease. OBJECTIVE：To retrospectively summarize the experience of combined coronary artery bypass grafting and valvular procedure. METHODS：Total y 51 patients who underwent combined heart valve surgery and coronary artery bypass grafting were retrospectively analyzed, including 10 cases with aortic valve replacement, 14 cases with mitral valve replacement, eight cases with mitral valve replacement combined with tricuspid annuloplasty, four cases with aortic valve and mitral valve replacement, three cases with aortic valve and mitral valve replacement combined with tricuspid annuloplasty, seven cases with mitral valvuloplasty, and five cases with mitral valvuloplasty combined with tricuspid annuloplasty. 〈br〉 RESULTS AND CONCLUSION：Biovalve replacement was performed in nine patients, mechanical valves replacement in 31 cases, mitral valvuloplasty in 11 cases and tricuspid annuloplasty in 16 cases. There were total y 109 bypass graft vessels, and the average number of coronary artery bypass grafts was （1.92±0.73） branches. Four cases died within 30 days postoperatively, and 47 patients were successful y discharged from the hospital. Forty-five of 47 discharging patients were fol owed for 3-48 months. One case died of cerebral infarction within 6 months postoperatively, and another case died of cardiac dysfunction over 1 year after operation. The heart function of 45 survival patients was significantly improved. The comprehensive analysis showed that improving the heart function preoperatively, strengthening myocardial protection, shortening operation and myocardial ischemia time, and complete revascularization are the key factors for successful operation.