Concomitant cardiac valve replacement and coronary artery bypass grafting

doi:10.3969/j.issn.2095-4344.2014.05.008

Abstract

Abstract:

BACKGROUND: Heart valve surgery combined with coronary artery bypass grafting has been gradually used for treatment of coronary heart disease combined with cardiac valve disease.

OBJECTIVE: To retrospectively summarize the experience of combined coronary artery bypass grafting and valvular procedure.

METHODS: Totally 51 patients who underwent combined heart valve surgery and coronary artery bypass grafting were retrospectively analyzed, including 10 cases with aortic valve replacement, 14 cases with mitral valve replacement, eight cases with mitral valve replacement combined with tricuspid annuloplasty, four cases with aortic valve and mitral valve replacement, three cases with aortic valve and mitral valve replacement combined with tricuspid annuloplasty, seven cases with mitral valvuloplasty, and five cases with mitral valvuloplasty combined with tricuspid annuloplasty.

RESULTS AND CONCLUSION: Biovalve replacement was performed in nine patients, mechanical valves replacement in 31 cases, mitral valvuloplasty in 11 cases and tricuspid annuloplasty in 16 cases. There were totally 109 bypass graft vessels, and the average number of coronary artery bypass grafts was (1.92±0.73) branches. Four cases died within 30 days postoperatively, and 47 patients were successfully discharged from the hospital. Forty-five of 47 discharging patients were followed for 3-48 months. One case died of cerebral infarction within 6 months postoperatively, and another case died of cardiac dysfunction over 1 year after operation. The heart function of 45 survival patients was significantly improved. The comprehensive analysis showed that improving the heart function preoperatively, strengthening myocardial protection, shortening operation and myocardial ischemia time, and complete revascularization are the key factors for successful operation.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: biocompatible materials, heart valves, coronary artery bypass, off-pump, mitral valve

CLC Number:

R318

Ma Song-feng, Cao Hui, Zheng Feng, Qiao Jun, Zhang Guo-ming. Concomitant cardiac valve replacement and coronary artery bypass grafting[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(5): 699-704.

Figures/Tables 2

2.1 参与者数量分析按意向性分析处理，51例患者均进入结果分析。 2.2 手术完成情况本组51例接受手术治疗，置换生物瓣膜者9例，机械瓣膜者31例，二尖瓣成形11例，在原手术另附加三尖瓣成形15例。共移植旁路血管109支，每例1-3支，冠状动脉平均搭桥(1.92±0.73)支。同时行主动脉瓣置换10例，移植血管1-3支；二尖瓣置换15例，移植血管1-3支；二尖瓣置换+三尖瓣成形8例，移植血管1-3支；双瓣置换4例，移植血管1-3支；双瓣置换及三尖瓣成形3例，移植血管一两支；二尖瓣成形7例，移植桥血管1-3支；二尖瓣、三尖瓣成形4例，移植血管一两支。35例(68%)移植大隐静脉，4例(8%)移植左乳内动脉，11例(15%)移植大隐静脉+左乳内动脉，1例(2%)移植桡动脉+左乳内动脉。二次手术3例中，1例术后渗血多，均经再次开胸止血处理；2例因切口感染而行清创术。术后早期(30 d内)死亡4例(8%)，其中2例为双瓣置换，1例为二尖瓣置换，分别移植2支桥，均死于低心输出量综合征；另1例主动脉瓣置换移植1支桥的66岁男性患者死于脑梗死。 2.3 随访结果 47例患者无围术期心肌梗死及其他并发症发生顺利出院；2例失访，45例随访3-48个月，平均9.4个月，随访率96%(45/47)；1例半年后死于脑梗死，1例于术后1年多死于心脏功能不全。随访3个月时，45例多普勒照声心动图结果显示，左心室舒张末内径 (51.77± 2.64) mm，较术前(58.92±3.81) mm明显缩小(P < 0.05)。心功能评估结构显示，Ⅰ级5例，Ⅱ级36例，Ⅲ级心功能2例，心功能较术前明显提高(P < 0.05)；除有2例需药物治疗心缓解绞痛症状外，其余原有心绞痛症状均消失，与术前比较差异有非常显著性意义(P < 0.01)。存活患者心功能有明显的改善，均可进行常人的一般生活及活动或恢复原来的一般轻工作(表1)。"

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