中国全科医学2017，Vol.20Issue(35)：4367-4371,5.DOI:10.3969/j.issn.1007-9572.2017.00.054
冠状动脉旁路移植术同期行心脏瓣膜处理和/或室壁瘤切除临床疗效及12年随访分析研究
Outcome of Concomitant Coronary Artery Bypass Grafting with Heart Valve Replacement and/ or Ventricular Aneurysm Resection:a 12-year Follow-up Study
摘要
Abstract
Objective To investigate the clinical outcomes of concomitant on-pump coronary artery bypass grafting (ONCABG)with heart valve replacement and/ or ventricular aneurysm resection by analyzing the results of a 12-year follow -up. Methods The enrolled participants were 32 cases underwent concomitant ONCABG with heart valve replacement and/ or ventricular aneurysm resection (concomitant group)and 97 cases underwent ONCABG (ONCABG group)in Guangdong Provincial Hospital of TCM between May 1999 and December 2007. All of them were followed up till October 2016. The preoperative and postoperative clinical data of them were collected,including major cardiovascular indicators and survival status. Results Before the surgery,the left ventricular ejection fraction (LVEF),prevalence of unstable angina pectoris,left main coronary artery lesions and hypertension,number of lesion vessels in the concomitant group were less than those in the ONCABG group (P < 0. 05),but left ventricular end-diastolic diameter (LVEDD)was higher than that in the ONCABG group (P <0. 05). Patients in the concomitant group had less mean number of distal anastomoses,but longer mean duration of surgery, duration of mechanical ventilation,length of postoperative ICU stay,and length of postoperative hospital stay,higher incidence of postoperative low cardiac output syndrome,postoperative renal dysfunction and postoperative arrhythmia,more average total dose of dopamine and nitroglycerin used postoperatively and higher in-hospital mortality than those in the ONCABG group (P <0. 05). Among the 123 case survived,83 (67. 5%)cases were followed up for 8 to 18 years,with an average of (12. 1 ± 2. 7) years. The rate of follow-up was 85. 2% (23 / 27)for the concomitant group,while 62. 5% (60 / 96)for the ONCABG group. During the follow-up period,two groups presented similar incidence of chest distress and angina pectoris,lower incidence of ST-T wave changes or arrhythmia and recurrent acute myocardial infarction (AMI),similar rate of retreatment by PCI,rates of deaths from cardiac causes and non-cardiac causes and total death rate (P > 0. 05),but concomitant group had higher incidence of cardiac failure and higher rate of increased LVEDD,but lower rate of decreased LVEF than the ONCABG group (P< 0. 05). The rate of vascular graft occlusion in the ONCABG group was not significantly different from that in the concomitant group during the follow-up period 〔20. 0% (17 / 85)vs. 35. 4% (17 / 48),χ2 = 3. 832,P = 0. 063〕. Conclusion Although patients in the concomitant group have more perioperative complications and higher in-hospital mortality,they have similar long-term survival outcome as those in the ONCABG group.关键词
冠状动脉旁路移植术/心脏瓣膜疾病/心脏室壁瘤/随访研究Key words
Coronary artery bypass/Heart valve diseases/Heart aneurysm/Follow-up studies分类
医药卫生引用本文复制引用
胡佳心,阮新民,林宇..冠状动脉旁路移植术同期行心脏瓣膜处理和/或室壁瘤切除临床疗效及12年随访分析研究[J].中国全科医学,2017,20(35):4367-4371,5.基金项目
广东省科技计划资助项目(2014A020212271)——基于PI3K/AKT/Fox01通路研究调脾护心方抑制静脉桥狭窄的分子机制 （2014A020212271）
