2021美国胸外科协会缺血性心肌病伴心力衰竭冠状动脉旁路移植术专家共识解读  

Interpretation of the American Association for Thoracic Surgery expert consensus document:coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure in 2021

作　　者：陈绪军 刘达兴 黄克力[3] 季强[4] 董然[5] 郭惠明[6] Chen Xujun;Liu Daxing;Huang Keli;Ji Qiang;Dong Ran;Guo Huiming(Department of Cardiac Surgery,Wuhan First Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Cardiovascular Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China;Cardiac Surgery Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China;Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Surgical Center for Coronary Artery Disease,Beijng Anzhen Hospital,Beijng 100029,China;Department of Cardiac Surgery,Guangdong Provincial People′s Hospital,Guangzhou 510080,China)

机构地区：[1]华中科技大学同济医学院武汉市第一医院心血管外科,武汉430022 [2]遵义医科大学附属医院心脏大血管外科,遵义563000 [3]四川省人民医院心脏外科中心,成都610072 [4]复旦大学中山医院心血管外科,上海200032 [5]首都医科大学北京安贞医院冠脉外科中心,北京100029 [6]广东省人民医院心外科,广州510080

出　　处：《中华医学杂志》2021年第36期2825-2830,共6页National Medical Journal of China

摘　　要：2021年5月美国胸外科协会发布了缺血性心肌病伴心力衰竭的冠状动脉旁路移植术(CABG)临床应用专家共识。该共识建议术前多学科参与,积极对缺血性心肌病进行评估,包括心肌活力、瓣膜功能等;术中采用多支动脉桥、含血心肌保护液行心脏停跳的CABG,同期积极处理二尖瓣关闭不全并重视心律失常处理,积极使用包括主动脉内球囊反搏在内的心脏机械辅助装置;术后采用多学科团队规范化重症监护病房的各项治疗,继续合理使用心脏辅助装置,重视心脏起搏治疗并在出院后90 d内密切随访等措施降低缺血性心肌病CABG的手术死亡率,减少围手术期并发症并改善预后。An expert consensus on coronary artery bypass grafting(CABG)in patients with ischemic cardiomyopathy(ICM)was released by the American Association for Thoracic Surgery in May 2021,which contains a vast array of perioperative recommendations.During preoperative period,a comprehensive assessment on ICM including myocardial viability and valve function by a multi‐disciplinary team(MDT)approach should be performed.In terms of intraoperative period,multiple arterial conduits and on‐pump CABG using cold blood cardioplegia should be considered,meanwhile,other aspects involving concomitant management of mitral valve regurgitation and arrythmia,as well as active use of mechanical cardiac assist devices(e.g.,intra‐aortic balloon pump)should also be achieved.Finally,a range of postoperative interventions which includes standardized MDT management in intensive care unit(ICU),continuous use of cardiac assist devices,cardiac pacing,close follow‐up within 90 days and drug treatment strictly guided by the guidelines after discharge from hospital should be conducted.The above‐mentioned perioperative bundled care might reduce perioperative complications and operative mortality,and thus improve the prognosis of the patients with ICM.

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 心肌病 专家共识 解读 

分 类 号：R654.2[医药卫生—外科学]