再次冠状动脉旁路移植术42例临床分析

摘要

Objective To determine the clinical characteristics and outcomes of redo CABG.Methods The outcomes of 42 consecutive patients who underwent redo CABG from January 2002 to December 2010 was analyzed.There were 29 males and 13 females,aging from 46 to 78 years old with a mean of(61.2 ± 2.1)years.Off-pump CABG was applied for 31 patients and on-pump CABG for 11 patients.There were 1 patient underwent concomitant aortic valve replacement and 1 patient underwent aortic root and right aortic arch replacement respectively.Results Three patients died of right ventricle rupture,heart failure and multiple system organ failure respectively and the perioperative mortality rate was 4.8%.The post-operatively mechanical ventilation time varied from 9 to 27 h with a mean of(17 ±7)h.There was no residual angina and perioperative myocardial infarction in the remaining patients who were all discharged uneventfully.Intraoperative 6 patients had accepted intraaortic balloon counterpulsation.During the followup from 6 months to 4.5 years for 38 patients,which showed no evidence of recurrent angina and postoperative coronary CT angiography in 12 patients showed the patency of grafts is good.Conclusion Satisfactory outcome of redo coronary artery bypass grafting can be achieved if proper indication were choosed and reasonable management were performed.%目的 总结再次冠状动脉旁路移植术(CABG)的临床特点及手术效果.方法 对2002年1月至2010年12月连续收治的42例CABG术后患者行再次CABG.其中男性29例,女性13例;年龄46～78岁,平均(61.2±2.1)岁.非体外循环CABG患者31例,心肺转流下CABG患者11例,同期分别行主动脉瓣置换术及主动脉根部替换+右半主动脉弓置换术各1例.结果 全组死亡3例,1例因术中右心室破裂死亡,1例因术后心力衰竭死亡,1例发生肾功能衰竭导致多器官功能衰竭死亡,围手术期病死率为4.8%.其余40例术后呼吸机辅助呼吸时间9～27 h,平均(17±7)h.术后心绞痛均消失,围手术期无心肌梗死发生,顺利恢复出院.术中接受主动脉内球囊反搏6例.术后随访38例,随访时间6～54个月,均无心绞痛发作;12例复查冠状动脉CTA,显示移植血管均通畅.结论 随着手术技巧和围手术期管理的改进,合理采用各种技术,再次冠状动脉旁路移植术可以取得满意疗效.