同期心脏瓣膜手术与冠脉旁路移植术的临床研究
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摘要
目的分析不同年龄组同期施行心脏瓣膜手术和冠状动脉旁路移植术(CABG)的效果及临床经验。方法同期接受心脏瓣膜手术和CABG的患者80例,根据年龄分为≥60岁组(n=44)和<60岁组(n=36),均在全麻体外循环(CBP)下完成手术,其中二尖瓣置换(MVR)42例,主动脉瓣置换(AVR)23例,双瓣膜置换(DVR)15例。术中搭桥平均(1.5±0.6)支,其中1支桥38例,2支桥27例,多支桥15例。共移植旁路血管127支。结果两组患者术后呼吸机辅助通气时间、CSICU监护时间、住院时间、围术期并发症、死亡率比较,差异均无统计学意义(P>0.05)。随访79例,失访5例,1例3个月后死于严重低心排综合征(LCOS),1例1年后因瓣周漏(PVL)行2次换瓣,2例出现脑血管意外。其余患者生活质量改善明显,心功能Ⅰ级56例、Ⅱ级14例。结论心脏瓣膜手术联合CABG是治疗心脏瓣膜病变合并冠心病的有效方法,可使患者获得满意的治疗效果。
Objective To analyze the results and experiences of cardiac valve surgery combined with coronary artery bypass grafting( CABG) in different age groups. Methods The clinical data of 80 patients,who received cardiac valve surgery combined with CABG,were divided into ≥60 years group( 44 cases) and< 60 years group( 36 cases),according to their ages. All the operations were performed under general anesthesia and cardiopulmonary bypass( CPB),including mitral valve replacement( MVR) in 42 cases,aortic valve replacement( AVR) in 23 cases and dual valve replacement( DVR) in 15 cases. The mean grafts number was( 1. 5 ± 0. 6) branches. Among the CABG,38,27 and 15 cases were transplanted with 1,2,and multiple grafts respectively. A total of 127 bypass grafts were grafted. Results There were no significant differences in the duration of postoperative ventilator-assisted ventilation, CSICU monitoring time,hospitalization time, perioperative complications and mortality between the two groups( P > 0. 05).79 patients were followed up,5 patients lost,1 patient died of severe Low Cardiac Output Syndrome( LCOS)after 3 months,1 patient suffered from para-valvular leakage( PVL) operated the second valve replacement in1 year later,2 patients had cerebro-vascular accident. The remaining patients improved the quality of life significantly,56 patients were in NYHA class Ⅰ,14 patients were in NYHA class II. Conclusion Cardiac valve surgery combined with CABG is an effective method in the treatment of heart valvular disease with coronary heart disease,which can make the elderly patients obtain satisfactory therapeutic effect.
Objective To analyze the results and experiences of cardiac valve surgery combined with coronary artery bypass grafting( CABG) in different age groups. Methods The clinical data of 80 patients,who received cardiac valve surgery combined with CABG,were divided into ≥60 years group( 44 cases) and< 60 years group( 36 cases),according to their ages. All the operations were performed under general anesthesia and cardiopulmonary bypass( CPB),including mitral valve replacement( MVR) in 42 cases,aortic valve replacement( AVR) in 23 cases and dual valve replacement( DVR) in 15 cases. The mean grafts number was( 1. 5 ± 0. 6) branches. Among the CABG,38,27 and 15 cases were transplanted with 1,2,and multiple grafts respectively. A total of 127 bypass grafts were grafted. Results There were no significant differences in the duration of postoperative ventilator-assisted ventilation, CSICU monitoring time,hospitalization time, perioperative complications and mortality between the two groups( P > 0. 05).79 patients were followed up,5 patients lost,1 patient died of severe Low Cardiac Output Syndrome( LCOS)after 3 months,1 patient suffered from para-valvular leakage( PVL) operated the second valve replacement in1 year later,2 patients had cerebro-vascular accident. The remaining patients improved the quality of life significantly,56 patients were in NYHA class Ⅰ,14 patients were in NYHA class II. Conclusion Cardiac valve surgery combined with CABG is an effective method in the treatment of heart valvular disease with coronary heart disease,which can make the elderly patients obtain satisfactory therapeutic effect.
引文
[1]Thalji NM,Suri RM,Daly RC,et al.Assessment of coronary artery disease risk in 5463 patients undergoing cardiac surgery:when is preoperative coronary angiography necessary?[J].J Thorac Cardiovasc Surg,2013,146(5):1055-1064.
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[7]姜胜利,高长青,李伯君,等.冠心病合并心脏瓣膜疾病的手术治疗[J].解放军医学杂志,2005,30(8):668-669.
[8]Yu Y,Gao C,Li G,et al.Mitral valve replacement with complete mitral leaflet retention:operative techniques[J].J Heart Valve Dis,1999,8(1):44-46.
[9]Akins CW,Hilgenberg AD,Vlahakes GJ,et al.Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting[J].Ann Thorac Surg,2002,74(4):1098-1106.
[10]Schurr P,Boeken U,Limathe J,et al.Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting[J].Acta Cardiol,2010,65(4):441-447.
[11]徐东,张建,刘燕晖,等.冠状动脉搭桥同期行瓣膜置换术近期疗效[J].首都医科大学学报,2006,27(4):531-533.
[12]陈祥舟,刘梅,彭莉,等.瓣膜病同时合并冠心病体外循环中的心肌保护[J].中国体外循环杂志,2010,8(4):232-235,214.
[13]李细森,郑宝石.心脏瓣膜置换术同期行冠状动脉旁路移植术围手术期的护理[J].微创医学,2014,9(5):624-625,621.
[14]Lorusso R,Gelsomino S,Carella R,et al.Impact of prophylactic intra-aortic balloon counter-pulsation on postoperative outcome in high-risk cardiac surgery patients:a multicentre,propensity-score analysis[J].Eur J Cardiothorac Surg,2010,38(5):585-591.
[15]殷恩智,田伟臣,李刚,等.同期行冠状动脉旁路移植和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床研究[J].现代生物医学进展,2014,14(10):1890-1892.
[2]Rossi A,Bertagnolli G,Cicoira M,et al.Association of aortic valve sclerosis and coronary artery disease in patients with severe nonischemic mitral regurgitation[J].Clin Cardiol,2003,26(12):579-582.
[3]Pereira JJ,Balaban K,Lauer MS,et al.Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery[J].Am J Med,2005,118(7):735-742.
[4]Smith WT 4th,Ferguson TB Jr,Ryan T,et al.Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement?A decision analysis approach to the surgical dilemma[J].J Am Coll Cardiol,2004,44(6):1241-1247.
[5]Perrault LP,Moskowitz AJ,Kron IL,et al.Optimal surgical management of severe ischemic mitral regurgitation:to repair or to replace?[J].J Thorac Cardiovasc Surg,2012,143(6):1396-1403.
[6]Lorusso R,Gelsomino S,Vizzardi V,et al.Mitral valve repair or replacement for ischemic mitral regurgitation?The Italian Study on the Treatment of Ischemic Mitral Regurgitation(IS TIMIR)[J].J Thorac Cardiovasc Surg,2013,145(1):128-139.
[7]姜胜利,高长青,李伯君,等.冠心病合并心脏瓣膜疾病的手术治疗[J].解放军医学杂志,2005,30(8):668-669.
[8]Yu Y,Gao C,Li G,et al.Mitral valve replacement with complete mitral leaflet retention:operative techniques[J].J Heart Valve Dis,1999,8(1):44-46.
[9]Akins CW,Hilgenberg AD,Vlahakes GJ,et al.Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting[J].Ann Thorac Surg,2002,74(4):1098-1106.
[10]Schurr P,Boeken U,Limathe J,et al.Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting[J].Acta Cardiol,2010,65(4):441-447.
[11]徐东,张建,刘燕晖,等.冠状动脉搭桥同期行瓣膜置换术近期疗效[J].首都医科大学学报,2006,27(4):531-533.
[12]陈祥舟,刘梅,彭莉,等.瓣膜病同时合并冠心病体外循环中的心肌保护[J].中国体外循环杂志,2010,8(4):232-235,214.
[13]李细森,郑宝石.心脏瓣膜置换术同期行冠状动脉旁路移植术围手术期的护理[J].微创医学,2014,9(5):624-625,621.
[14]Lorusso R,Gelsomino S,Carella R,et al.Impact of prophylactic intra-aortic balloon counter-pulsation on postoperative outcome in high-risk cardiac surgery patients:a multicentre,propensity-score analysis[J].Eur J Cardiothorac Surg,2010,38(5):585-591.
[15]殷恩智,田伟臣,李刚,等.同期行冠状动脉旁路移植和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床研究[J].现代生物医学进展,2014,14(10):1890-1892.