瓣膜手术同期行冠脉搭桥手术35例体会  

Evaluation of combined valve operation and coronary artery bypass grafting

作　　者：杨崛圣[1] 项海燕[1] 徐建军[1] 陈向来[1] 龙翔[1] 唐燕华[1] 

机构地区：[1]南昌大学第二附属医院心胸外科,南昌330006

出　　处：《江西医药》2015年第10期976-979,共4页Jiangxi Medical Journal

摘　　要：目的总结瓣膜手术同期行冠状动脉旁路移植术的体会。方法 2009年5月-2014年6月我科住院患者共35例患者,男28例,女7例;年龄45岁-68岁(62±4.67岁);入院心功能分级(NYHA)Ⅱ级17例,Ⅲ级11例,Ⅲ-Ⅳ级7例;冠脉造影均提示冠状动脉病变。中度低温体外循环心脏停跳下行手术治疗,先行桥血管远端吻合及乳内吻合,再行瓣膜成形术或置换术;静脉桥血管近端吻合在主动脉开放后完成。组内患者行二尖瓣机械瓣置换术6例,生物瓣置换术6例;二尖瓣机械瓣膜置换术+三尖瓣成形术7例,二尖瓣生物瓣膜置换术+三尖瓣成形术8例;主动脉瓣机械瓣膜置换1例、生物瓣置换术1例;二尖瓣成形2例;二尖瓣成形+三尖瓣成形1例;二尖瓣机械瓣置换+主动脉瓣机械瓣置换+三尖瓣成形3例。桥血管数量:1根28例;2根4例;3根1例;4根2例。结果围手术期死亡1例,ICU停留时间2-17d(3.28±2.83d),住院时间11-34d(19.4±4.61d)。结论冠状动脉旁路移植术同期行瓣膜手术效果确切、安全可靠。Objective To summarize the experience of combined valve operation and coronary artery bypass grafting. Methods A total of 35 patients hospitalized in our department have been investigated from May 2009 to June 2014 B,including 28 cases male,7 cases female,age range of 45-68 years（62±4.67 years）,heart function classification（NYHA）：grade II 17 cases,grade Ⅲ11 cases,gradeⅢ-Ⅳ 7 cases. All cases have been diagnosed by coronary angiography. Cardiac operations have been performed under moderate hypothermic cardiopulmonary bypass. Vascular anastomosis and/or the bridge internal mammary anastomosis have been operated first,then revalvuloplasty or replacement has been performed;vein grafts in the proximal anastomosis have been achieved after aortic opening. Within the group of patients,6 cases underwent mechanical mitral valve replacement,6 cases underwent bioprosthetic mitral valve replacement;7 cases underwent mitral valve replacement plus three tricuspid valve plasty;8 cases underwent mitral bioprosthetic replacement plus three tricuspid valve plasty;1 cases underwent mechanical aortic valve replacement,1 cases underwent biological valve replacement;two tip 2 cases underwent mitral valvuloplasty;1case underwent two tricuspid plus three tricuspid annuloplasty;3 cases underwent mitral valve replacement plus aortic valve replacement plus three tricuspid annuloplasty. Bridge vessel number is listed as follows： 1 of 28 cases;2 of 4 cases;3 of 1 case;4 of 2 cases. Results There was no operative death but one case of perioperative death among the 35 patients. cases of all patients had no operation death,Total heart ICU monitoring time in all patients was 2-17 days（3.28 ±2.83 days）. Hospitalization Total hospitalization time was 11-34days（19.4±4.61 days）. Conclusion Coronary artery bypass grafting is effective,safe and reliable operation of valve.

关 键 词：瓣膜手术 冠状动脉旁路移植术 同期手术 

分 类 号：R654.2[医药卫生—外科学]