Objective To investigate the clinical outcomes of concomitant on-pump coronary artery bypass grafting (ONCABG)with heart valve replacement and/ or ventricular aneurysm resection by analyzing the results of a 12-year follow -up. Methods The enrolled participants were 32 cases underwent concomitant ONCABG with heart valve replacement and/ or ventricular aneurysm resection (concomitant group)and 97 cases underwent ONCABG (ONCABG group)in Guangdong Provincial Hospital of TCM between May 1999 and December 2007. All of them were followed up till October 2016. The preoperative and postoperative clinical data of them were collected,including major cardiovascular indicators and survival status. Results Before the surgery,the left ventricular ejection fraction (LVEF),prevalence of unstable angina pectoris,left main coronary artery lesions and hypertension,number of lesion vessels in the concomitant group were less than those in the ONCABG group (P < 0. 05),but left ventricular end-diastolic diameter (LVEDD)was higher than that in the ONCABG group (P <0. 05). Patients in the concomitant group had less mean number of distal anastomoses,but longer mean duration of surgery, duration of mechanical ventilation,length of postoperative ICU stay,and length of postoperative hospital stay,higher incidence of postoperative low cardiac output syndrome,postoperative renal dysfunction and postoperative arrhythmia,more average total dose of dopamine and nitroglycerin used postoperatively and higher in-hospital mortality than those in the ONCABG group (P <0. 05). Among the 123 case survived,83 (67. 5%)cases were followed up for 8 to 18 years,with an average of (12. 1 ± 2. 7) years. The rate of follow-up was 85. 2% (23 / 27)for the concomitant group,while 62. 5% (60 / 96)for the ONCABG group. During the follow-up period,two groups presented similar incidence of chest distress and angina pectoris,lower incidence of ST-T wave changes or arrhythmia and recurrent acute myocardial infarction (AMI),similar rate of retreatment by PCI,rates of deaths from cardiac causes and non-cardiac causes and total death rate (P > 0. 05),but concomitant group had higher incidence of cardiac failure and higher rate of increased LVEDD,but lower rate of decreased LVEF than the ONCABG group (P< 0. 05). The rate of vascular graft occlusion in the ONCABG group was not significantly different from that in the concomitant group during the follow-up period 〔20. 0% (17 / 85)vs. 35. 4% (17 / 48),χ2 = 3. 832,P = 0. 063〕. Conclusion Although patients in the concomitant group have more perioperative complications and higher in-hospital mortality,they have similar long-term survival outcome as those in the ONCABG group.%目的 探讨冠状动脉旁路移植术(ONCABG)同期行心脏瓣膜处理和/或室壁瘤切除的临床疗效及12年随访结果.方法 选取1999年5月—2007年12月在广东省中医院完成ONCABG同期行心脏瓣膜处理和/或室壁瘤切除术患者32例(同期手术组)和单纯ONCABG患者97例(单纯手术组).收集其术前、术后临床资料,并对其进行随访,随访至2016年10月,观察心血管主要指标和生存状况等.结果 同期手术组术前左心室射血分数(LVEF),术前不稳定型心绞痛、左主干病变所占比例,病变血管数,高血压病史所占比例低于单纯手术组,左心室舒张末期内径高于单纯手术组(P<0.05).同期手术组平均远端吻合口数低于单纯手术组,手术时间、术后机械通气时间、术后ICU时间、术后住院天数、低心排综合征、术后肾功能不全、术后多巴胺用量、术后硝酸甘油用量、术后心律失常、住院死亡率高于单纯手术组(P<0.05).术后123例患者存活,83例(67.5%)患者随访8~18年,平均随访时间为(12.1±2.7)年;其中同期手术组随访率为85.2%(23/27),单纯手术组随访率为62.5%(60/96).两组胸闷、心绞痛等症状发生率、新出现的ST-T改变或心律失常发生率、再发急性心肌梗死(AMI)率、再次经皮冠状动脉介入治疗(PCI)处理率、因心脏事件死亡率、因心脏以外事件死亡率、总死亡率比较,差异均无统计学意义(P>0.05);同期手术组心力衰竭症状发生率、左心室舒张末期内径高于单纯手术组,LVEF低于单纯手术组(P<0.05).单纯手术组血管桥闭塞率为20.0%(17/85),同期手术组为35.4%(17/48);两组血管桥闭塞率比较,差异无统计学意义(χ2=3.832,P=0.063).结论 ONCABG同期行心脏瓣膜处理和/或室壁瘤切除,围术期并发症和死亡率高,但术后长期随访与单纯ONCABG相比,生存结局相似.
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