左冠状动脉主干外科血管成形术的远期疗效

摘要

Objective To assess long-term outcome of coronary artery diseased patients undergone the surgical angioplasty of left main coronary artery.Methods From September 1983 to December 2004,162 patients were operated on for left main coronary artery stenosis with surgical angioplasty.The data were retrospectively analyzed.Operative death associated factors were evaluated with univariate analysis,and long-term survival was estimated by Kaplan-Meier analysis.Results The in-hospital mortality was 8%for all the patients but only 5.1%for the patients with simple left main coronary artery stenosis.A significant drop of operative mortality was noted in the later era of treatment(1983 to 1994 vs.1994 to 2004).The operative death was more likely associated with no-isolated left main coronary artery pathologic feature and the urgency of surgery.An average of 102(8 to 264)months'follow-up was completed in 95%of discharged patients.Coronary event occurred in 42 patients in the follow-up period and it was mortal for 9 cases.The overall long-term survival was 81%at 10 years and 52%at 20 years.The coronary event-free survival was 77%at 10 years and 41%at 20 years.Conclusions Surgical angioplasty of left main coronary artery could produce excellent long-term outcome with acceptable per-operative mortality in left main coronary artery stenosis patients.This technique should deserve an important place in therapeutic options for this cohort of patients.%目的 评估左冠状动脉主干外科血管成形术治疗以左冠状动脉主干狭窄为主要病变的冠状动脉心脏病的远期疗效.方法 回顾性分析1983年9月至2004年12月因左冠状动脉主干狭窄接受左冠状动脉主干外科血管成形术治疗的162例患者的临床资料.采用单因素方差分析手术病死率相关因素,采用Kaplan-Meier生存曲线法分析远期生存率.结果 围手术期病死率8%,与是否为单纯左冠状动脉主干病变,是否为急诊手术相关.出院患者随访率95%,中位随访时间102个月.42例患者发生远期冠状动脉事件,9例患者死亡.10年及20年累计生存率分别为81%和52%,无冠状动脉事件生存率分别为77%和41%.结论 左冠状动脉主干外科血管成形术治疗以左冠状动脉主干狭窄为主要病变的冠状动脉心脏病,可以获得较好的远期疗效,具有良好的临床应用价值.