“分站式”杂交冠状动脉血运重建术治疗73例冠状动脉多支血管病变临床中期随访结果分析

发布时间：2019-01-01 19:49

【摘要】：目的:观察"分站式"杂交冠状动脉血运重建术(HCR)治疗冠状动脉多支血管病变中期随访结果,评价"分站式"HCR的可行性、安全性和疗效。方法:入选2012-01至2014-06因冠状动脉多支血管病变在我院行择期"分站式"HCR的患者共73例,其中男性50例(68.5%),女性23例(31.5%),平均年龄(61.1±10.7)岁,所有患者均为包括左前降支在内的多支病变。"分站式"HCR要点为:全麻双腔气管插管,左前胸第4或第5肋间小切口,直视下获取左乳内动脉,心脏跳动下完成左乳内动脉和左前降支的吻合。在小切口冠状动脉旁路移植术(CABG)术后3~7天,在介入导管室先行冠状动脉造影,观察左乳内动脉-左前降支旁路血管情况,证实其通畅后对非左前降支病变行经皮冠状动脉介入治疗(PCI)并置入支架。患者术后每年进行超声心动图、X线胸片和心电图检查,如患者出现心肌缺血表现,则进行冠状动脉增强计算机断层摄影术(CTA)或冠状动脉造影检查等。结果:本组患者均顺利施行"分站式"HCR,全组无手术死亡。外科手术时间(152.9±43.8)min,处理冠状动脉(2.6±0.5)支,术后总引流量(558.6±441.3)ml,输红细胞(0.8±1.9)U,机械通气时间(10.5±13.0)h。小切口CABG与PCI间隔时间(5.3±2.9)d,冠状动脉置入支架(1.6±0.7)枚。术后随访期间,主要不良心脑血管事件(MACCE)发生5例(6.8%),其中死亡1例(1.4%),再发心肌缺血3例(4.1%),需要接受CABG/PCI者1例(1.4%,因支架再狭窄,再次置入支架)。结论:"分站式"HCR是一种安全,有效的手术方式,其围手术期和中期随访结果满意,"分站式"HCR适合于左前降支严重病变无法接受PCI而右冠状动脉主干和(或)回旋支等非左前降支病变可以进行PCI的冠状动脉多支病变患者。
[Abstract]:Objective: to evaluate the feasibility, safety and curative effect of "sub-station" hybrid coronary artery revascularization (HCR) in the treatment of coronary artery disease. Methods: a total of 73 patients (50 males (68.5%) and 23 females (31.5%) were enrolled in elective "sub-station" HCR from January 2012 to June 2014 in our hospital because of multi-vessel coronary artery disease, including 50 males (68.5%) and 23 females (31.5%). The mean age was (61.1 卤10.7) years, and all patients were multivessel lesions, including left anterior descending artery. " The main points of HCR were as follows: intubation with double lumen under general anesthesia, small intercostal incision of the 4th or 5th intercostal incision of left anterior chest, obtaining left internal mammary artery directly, and anastomosis of left internal mammary artery and left anterior descending branch under beating heart. After small incision coronary artery bypass grafting (CABG), coronary angiography was performed in interventional catheterization to observe the left internal mammary artery and left anterior descending artery. After patency, percutaneous coronary intervention (PCI) and stent implantation were performed for non-left anterior descending artery lesions. The patients underwent echocardiography, chest radiography and electrocardiogram every year after operation, and coronary angiography (CTA) or coronary angiography (CAG) were performed in case of myocardial ischemia. Results: all the patients had no operative death after HCR,. The operative time was (152.9 卤43.8) min, to treat the coronary artery (2.6 卤0.5), the total drainage volume was (558.6 卤441.3) ml, and the mechanical ventilation time was (10.5 卤13.0) h. The interval between small incision CABG and PCI was (5.3 卤2.9) days, and coronary stent placement was (1.6 卤0.7) days. During the follow-up period, there were 5 cases (6.8%) with major adverse cardiovascular and cerebrovascular events (MACCE), 1 case (1.4%) died, 3 cases (4.1%) had recurrent myocardial ischemia, 1 case (1.4%) needed CABG/PCI. Because the stent is restenosis, place the stent again. Conclusion: the "sub-station" HCR is a safe and effective surgical method, and its perioperative and mid-term follow-up results are satisfactory. The "sub-station" HCR is suitable for patients with severe left anterior descending artery disease who cannot accept PCI, while right coronary artery trunk and / or non-left anterior descending artery disease, such as right coronary artery disease, can be performed in patients with multivessel coronary artery disease with PCI.
【作者单位】：北京大学第三医院心脏外科;北京大学第三医院心脏内科;
【分类号】：R654.2

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