摘要
目的：探讨心脏瓣膜替换并冠状动脉旁路移植同期手术指征、方法及围术期处理。方法：2003年1月至2008年12月我院同期施行心脏瓣膜替换并冠状动脉旁路移植手术40例，其中风湿性心脏瓣膜病并冠状动脉病变35例；冠心病并缺血性二尖瓣关闭不全2例，主动脉瓣退行性变3例；冠状动脉造影显示单支血管病变20例，双支12例，多支8例，施行二尖瓣替换29例，主动脉瓣替换7例，二尖瓣替换＋主动脉替换4例，同期施行三尖瓣成形10例，左心房血栓清除6例，室壁瘤切除3例。结果：全组病例无早期死亡，术后发生低心排出量综合征6例，呼吸衰竭3例，脑栓塞3例，肾功能衰竭1例。术后随访30例，随访时间1-60个月，除1例术后5年死于肝癌外，其余心功明显改善。结论：心脏瓣膜替换并冠状动脉旁路移植同期手术可获得良好效果。彻底解除瓣膜病变，充分心肌再血管化，良好的心肌保护和术后处理是获得手术成功的关键。
Objective：To discuss appropriately operative indication, method and prevention and treatment of perioprative complication of combined cardiac valve replacement with coronary artery Bapass grafting （CABG）. Method ： From Jan. 2003 to Dec. 2008, combined cardiac valve replacement with CABG was performed in 40 patients. Rheumatic heart disease with coronary artery disease was in 35, coronary artery disease with mitral valvelar dysfunction in 2, and aortic retrograde degeneration in 3. Single vessel disease was in 20, two vessels disease in 12 and triumple- vessel disease in 8. Mitral valve replecement（MVR） was performed in 29, aortic valve replacement （AVR） in 7and MVR ＋ AVR in 4, associated procedures were tricuspid annoloplasty in 10, left artrium thorombectomy in 6, and left ventricular aneurysm resection in 3. Result：No early death was found in this group. There were low cardiac output in 6, respirative failure in 3, cereboembolism in 3 and renal failure in 1. Follow-up 1 to 60 months,there was 1 death of hepatocareinoma, and other substantial improvement in cardial function. Conclusion： Combined one stage valve replacement and CABG is effective with acceptable morbidity and mortality. To resolve the valve disease completely, full revasculafization strategy, good myocardial protection and management of postoperative complication aer the key points to get good surgery results.
出处
《心肺血管病杂志》
CAS
2009年第5期301-303,共3页
Journal of Cardiovascular and Pulmonary Diseases
