冠心病合并心脏瓣膜疾病的手术治疗

目的总结冠心病合并心脏瓣膜疾病的外科治疗方法。方法1998年4月-2004年12月，同期治疗57例冠心病合并心脏瓣膜疾病患者，平均年龄60岁（42～78岁）；心功能Ⅱ级9例，Ⅲ级37例，Ⅳ级11例；二尖瓣病变37例，主动脉瓣病变11例，联合瓣膜病变9例；均伴有单支或多支冠状动脉病变。手术在中低温体外循环下进行。心脏停跳后先做静脉桥的远端吻合，然后处理瓣膜。心脏复苏后在升主动脉开放前完成大隐静脉与升主动脉的吻合。乳内动脉的吻合在瓣膜置换或成形后心脏复苏前完成。本组行二尖瓣成形8例，行二尖瓣置换29例，行主动脉瓣置换11例，行双瓣置换9例（其中39例为机械瓣置换，10例为进口生物瓣置换）。冠脉搭桥1～5支，平均2．7支／例。结果术后早期死亡1例，死亡率为1．75％，其余患者住院期间无严重并发症。随访6个月～7年，无死亡，患者生活质量均明显提高，心功能Ⅰ级45例，Ⅱ级11例。结论同期施行冠状动脉旁路术和心脏瓣膜术安全有效。

Surgical management of coronary artery disease associated with valvular heart disease

Objective To review the experience of surgical management of coronary artery disease associated with valvular heart disease. Methods From 1998 to 2004, fifty-seven patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60 years. Heart function (NYHA) was class II in 9 patients, class III in 37, class IV in 11. 37 patients had mitral valve lesion, 11 aortic valve lesion, and 9 with lesions of both valves. 26 cases had single-vessel disease, 20 with double-vessel disease,11 with triple-vessel disease, and 9 with main artery lesion. After cardiac arrest with the aid of cold cardioplegia under moderate cardiopulmonary bypass, distal anastomosis of the saphenous vein (SV) to the target vessels was first performed followed by valve replacement (49 patients) or valvular plasty (8 patients). The left mammary artery was grafted to the left anterior descending artery before aortic declamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping was 112.6 min. Results Except one patient, no mortality and severe morbidity occurred during hospitalization. Heart function was improved to class I-II and no one died during follow-up period. Conclusion CABG combined with valve surgery can be safely performed with good results.