同期行冠状动脉旁路移植术及心脏瓣膜手术99例分析

摘要

目的：探讨同期行冠状动脉旁路移植术（CABG）和心脏瓣膜置换术的可行性、安全性和总结临床经验。方法回顾分析99例同期行CABG和心脏瓣膜置换术患者资料。术前心功能（NYHA）II级25例，III级65例，IV级9例。二尖瓣病变66例，主动脉瓣病变21例，二尖瓣合并主动脉瓣病变12例。冠状动脉病变单支42例，2支27例，多支30例，左主干病变8例。术前心肌梗死13例，房颤43例，左房血栓19例。共移植桥血管195支，其中LIMA61支，SV 134支，平均每例患者（1.97±1.0）支；MVR43例，MVP23例，AVR21例，AVR+MVR12例，TVP23例。左心房血栓清除术19例，室壁瘤切除术3例，升主动脉成形术3例，脓肿清除术2例。结果3例术后30d内死亡（2例因低心排、多器官功能衰竭，1例恶性心律失常死亡），97例痊愈出院。随访6~120个月，平均（27.3±15.3）个月，失访16例，随访期间死亡13例（6例心血管病因，7例非心血管病因）。术后患者心功能均得到明显改善，心绞痛发作明显减少；心功能（NYHA）I级56例，II级10例，III级2例。结论 CABG联合心脏瓣膜置换术可以完成心肌再血管化并纠正血流动力学紊乱，具有良好的远期疗效。%Objective To summarize the experience of combined coronary artery bypass grafting(CABG)and cardiac valve replacement as well as the long-term outcomes. Methods From Sept.2003 to Sept.2013,a total of 99 patients including 60 male and 39 female received combined coronary artery bypass grafting(CABG)and cardiac valve replacement in our hospital with an average age of 62.2±4.1 years. Heart function(NYHA)was as follow:class II in 25,class III in 65,class IV in 9. 66 patients had mitral valve lesion,21 with aortic valve lesion and 12 with double valve lesion. 42 cases had single-vessel disease,27 with double-vessel disease,30 with multivessel disease and 8 with left main artery stenosis. 13 cases had myocardial infarction,43 with atrial fibrillation,19 with left atrial thrombus prior to the operation. There were 195 grafts in all,including 61 artery grafts and 134 vein grafts. There were 43 patients undergoing a combination of CABG with mitral valve replacement,23 with mitral valve repairmen, 21 with aortic valve replacement and 12 with mitral valve and aortic valve(double valve)replacement. Moreover,there were 19 patients undergoing Left atrial thrombectomy,3 with Aneurysm resection,3 with Aortic valvuloplasty and 2 with Abscess dissection. Results Three patients died within 30 days after operation,because of low cardiac output syndrome with multiple organs failure and malignant arrhythmia. 97 patients had smooth recovery and discharged from hospital. 81 patients had completed follow up with 13 late death(6 for cardiovascular causes and 7 for other causes)in a mean follow-up period of 27.3±15.3 months. 68 patients were followed up with improved heart function and free of angina. 56 patients were in NYHA class I,10 in class II and 2 in class III. Conclusion With correcting the hemodynamics and revascularization,combined CABG and cardiac valve replacement is an effective way for treatment of coronary disease and heart valve disease,and has acceptable long-term outcomes.