摘要
目的回顾性分析我科同期行瓣膜置换及冠状动脉旁路移植手术的临床经验。方法 2002年2月至2009年12月我科同期施行心脏瓣膜置换及冠状动脉旁路移植术(coronary artery bypass grafting,CABG)73例。其中男性41例,女性32例。冠状动脉造影显示:单支血管病变31例,双支血管病变24例,多支血管病变18例。同期施行二尖瓣置换31例,主动脉瓣置换21例,二尖瓣及主动脉瓣病变20例,二尖瓣、主动脉瓣及三尖瓣置换1例。人均冠状动脉远端吻合(2.52±1.21)个。前降支采用左内乳动脉15例,余血管桥均采用静脉桥。术中有2例因低心排血量综合征植入主动脉内球囊反搏支持。结果术后早期(30 d内)死亡3例,病死率4.1%。1例同期行3个瓣膜置换及1支血管移植的53岁男性患者死于室颤;1例同期行二尖瓣置换及3支血管移植的62岁女性患者死于低心输出量综合征;1例同期行二尖瓣置换及1支血管移植的66岁男性患者死于脑梗塞;余病人顺利出院,无围术期心肌梗死发生。随访51例,随访时间3个月至8年,平均随访3.8年,患者心衰改善,心绞痛消失。结论同期施行心脏瓣膜置换及冠状动脉旁路移植手术治疗风湿性心脏病合并冠心病,技术可行,疗效可靠。可靠的瓣膜置换,完全的再血管化,良好的心肌保护,正确的围术期处理是成功的关键。
Objective To retrospectively analyze the clinical experiences and early surgical outcomes of the combined coronary artery bypass grafting（CABG） and cardiac valve replacement.Methods From Feb.2002 to Dec.2009,a total of 73 patients underwent combined valve surgery and CABG in our hospital.There were 41 males and 32 females.Coronary angiography revealed that there were 31 patients with single-vessel disease,24 with double-vessel disease and 18 with triple-vessel disease.All the patients received combined valve replacements and CABG under cardiopulmonary bypass.There were 31 patients undergoing a combination of CABG with mitral valve replacement,21 patients with aortic valve replacement,20 patients with mitral valve and aortic valve（double valve） replacement,and 1 patient with mitral valve and aortic valve and tricuspid valve（triple valve） replacement.The number of distal anastomosis was 2.52±1.21 with 15 left internalmammary arteries bypassed to left anterior descending.In 2 patients an intra-aortic balloon pump was utilized for low cardiac output syndrome.Results Three patients died within 30 d after operation.The hospital mortality was 4.1%.A 53-year-old man who had triple valve replacement and 1 graft died of ventricular fibrillation.A 62-year-old woman who had mitral valve and 3 grafts died of low cardiac output syndrome.A 66-year-old man who had mitral valve replacement and 1 graft died of cerebral infarction.The other 70 patients were discharged from hospital with improved heart function.There was no patient with perioperative myocardial infarction.Fifty-one patients were followed up from 3 months to 8 years（average 3.8 years）,and these survivors were in improved clinical condition and free of angina.Conclusion The combined operation of valve replacement and CABG is feasible and effective for patients with coexisting disease.Reliable valve replacement,complete myocardial revascularization,excellent myocardial protection and sound management of postoperative complication contribute to the success of operation.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2011年第4期411-413,共3页
Journal of Third Military Medical University
关键词
风湿性心脏病
冠心病
冠状动脉旁路移植术
瓣膜置换术
rheumatic heart disease
coronary artery heart disease
coronary artery bypass grafting
cardiac valve replacement
