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左桡动脉桥冠状动脉旁路移植术治疗右主干重度狭窄的中期结果

Mid-term outcomes of coronary artery bypass surgery with left radial artery bypassed to right main coronary artery of severe stenosis
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摘要 目的探讨左桡动脉桥冠状动脉旁路移植术(CABG)治疗冠心病右主干病变重度狭窄的效果.方法回顾性分析2014年9月至2019年4月在华中科技大学同济医学院武汉第一医院与遵义医科大学附属医院行全动脉CABG的47例合并右主干重度狭窄(≥90%)的冠心病患者资料,男31例,女16例,年龄41~73(56.5±9.7)岁.均为左桡动脉桥吻合于右主干,观察围手术期疗效并进行随访.结果47例患者均为全动脉CABG,均运用左乳内动脉(LIMA)与桡动脉桥.取带蒂LIMA 46支、左桡动脉47支、右桡动脉40支.LIMA吻合于前降支43例;右桡动脉37支吻合于对角支/中间支/钝缘支;左桡动脉全部吻合于远端右主干(慢性闭塞病变20例,≥90%狭窄27例),Y或T桥3支,其余均为单支桥.远端吻合口2~4(2.7±0.9)个.手术死亡1例,死于心包填塞.术后房颤3例,前臂血肿1例,急性肾功能不全1例,心肌梗死2例.气管插管时间3.5~20.3(8.3±4.7)h,术后住院6~13(7.1±2.9)d.随访3~47(23.3±7.5)个月,随访率86.96%(40/46).随访中无重要心血管事件发生,术后3个月平均左心室射血分数较术前改善(60.0%±4.0%比42.4%±7.5%,P=0.003).58.7%的患者(27/46)于术后(19.5±7.3)个月接受CT血管造影检查,均证实左桡动脉通畅.结论左桡动脉吻合于冠心病重度狭窄的右主干近期安全,中期效果良好. Objective To evaluate the mid-term outcomes of coronary artery bypass grafting(CABG)with left radial artery(RA)graft bypassed to right main coronary artery(RCA)of severe stenosis.Methods Between September 2014 and April 2019,a total of consecutive 47 patients who had severe stenosis(≥90%)of RCA underwent total arterial revascularization,with left RA bypassed to RCA.There were 31 males and 16 females,with a mean age of(56.5±9.7)years old.The perioperative outcomes were observed and mid-term results were followed up.Results A total of 46 left internal mammary artery(LIMA)grafts,47 left radial artery(LRA),and 40 right RA grafts(RRA)were harvested with pedicles.LIMA was bypassed to LAD in 43 patients,RRA was to diagonal branches,ramus or oblique marginal in 37 cases,and LRA was to RCA.All grafts(except 3 composite Y or T grafts)were single.Mean graft number was 2-4(2.7±0.9).There was one death due to cardiac tamponade.Three patients had postoperative atrial fibrillation,1 had a forearm hematoma,1 had acute renal insufficiency,and 2 had acute myocardial infarction.The mean tracheal intubation duration was 3.5-20.3(8.3±4.7)hours,and the mean hospital stay was 6-13(7.1±2.9)days.The average follow-up was 3-47(23.3±7.5)months,with a follow-up rate of 86.96%(40/46).There were no major cardiovascular events during the follow-up.Three month after surgery,the mean left ventricular ejection fraction was significantly improved than that of pre-operation(60.0%±4.0%vs 42.4%±7.5%,P=0.003).Computed tomography angiography(CTA)examination showed that 58.7%(27/46)of patients had patent LRA after a mean follow-up duration of(19.5±7.3)months.Conclusion CABG with LRA bypassed to RCA of severe stenosis proves to be safe and effective,with good mid-term outcomes.
作者 刘达兴 陈绪军 张建 陈新忠 罗刚 刘英杰 夏宇 田仁斌 Liu Daxing;Chen Xujun;Zhang Jian;Chen Xinzhong;Luo Gang;Liu Yingjie;Xia Yu;Tian Renbin(Department of Cardiac Surgery,First Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China;Department of Cardiac Surgery,Wuhan First Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Cardiovascular Surgery,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处 《中华医学杂志》 CAS CSCD 北大核心 2019年第42期3313-3317,共5页 National Medical Journal of China
关键词 冠状动脉分流术 冠状动脉疾病 桡动脉 冠状血管 右主干 Coronary artery bypass Coronary artery disease Radial artery Coronary vessel right main
作者简介 通信作者:陈绪军,Email:chenstan@163.com。
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