摘要
目的评价跨狭窄补片冠脉重建并旁路移植治疗弥漫性冠脉病变的近、中期效果。方法收集2013年1月-2015年6月在本院心血管外科行跨狭窄补片冠脉重建并旁路移植手术的患者34例(重建组),以及同期单纯行冠状动脉旁路移植手术患者132例(常规组)作为对照。观察两组旁路移植数目、体外循环时间、升主动脉阻断时间、手术死亡率、围术期并发症发生率、术后生存率、桥血管通畅率、主要心脑血管不良事件(major adverse cardiac and cerebral event,MACCE)。结果两组围术期死亡率、并发症发生率差异无统计学意义。重建组34例均得到随访,死亡1例,脑血管并发症1例;33例行冠状动脉CTA检查示所有动脉桥均通畅,1例静脉桥闭塞。常规组124例(94.0%)成功随访,死亡4例,1例心源性死亡,1例再发心梗,8例脑血管并发症;97例行冠状动脉CTA检查示1例乳内动脉桥闭塞,4例静脉桥闭塞。两组生存率、MACCE发生率、桥血管通畅率差异无统计学意义。结论采用跨狭窄补片冠脉重建并旁路移植治疗弥漫性冠状动脉病变不会增加围术期风险,术后近中期预后效果满意,对于弥漫性冠脉狭窄的病人是一种可行的治疗方式。
Objective To analyze the short and medium term outcome of the reconstruction and revascularization for diffuse coronary artery disease by coronary artery bypass grafting（CABG） plus repair with a patch across the stenosis.Methods Clinical data about 34 patients who underwent coronary artery reconstruction and bypass graft by repair with a patch across the stenosis（reconstruction group） in Chinese PLA General Hospital from January 2013 to June 2015 were retrospectively analyzed.Another 132 patient who underwent conventional CABG during the same period were selected as conventional group.The number of bypass grafts,cardiopulmonary bypass（CPB） time,aortic cross-clamping time,operative death,perioperative complications and patency rate,survival rate and the rate of MACCE were investigated and compared between two groups.Results There were no significant differences in perioperative mortality and incidence of complications between two groups.All cases were followed up in reconstruction group,one case died,and one case had cerebrovascular complication.Thirty-three patients received coronary artery CT angiography,no occlusion was found in IMA graft,and one SVG graft had occlusion.One hundred and twenty-four cases（94.0%） were followed up in conventional group.Four cases died including one case of cardiac death and one case of recurrence of MI.Eight cases had cerebrovascular complications.Ninety-seven patients received coronary artery CT angiography,one IMA graft and four SVG graft occlusion were found.The survival rate,incidence of MACCE and patency rate did not differ significantly between two groups.Conclusion Reconstruction and revascularization for diffuse coronary lesion by CABG plus repair with a patch across the stenosis is safe with excellent short and medium term outcome.This surgical technique is a useful option of revascularization for patients with diffuse coronary artery disease.
出处
《解放军医学院学报》
CAS
2016年第7期673-676,688,共5页
Academic Journal of Chinese PLA Medical School
基金
国家高技术研究发展计划(863)项目(2012AA0201104)~~
