Gangemi J J, Kron I L, Ross S D, Tribble C G, Kern J A
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
Cardiovasc Surg. 2000 Oct;8(6):452-6. doi: 10.1016/s0967-2109(00)00063-6.
The purpose of this study was to identify factors correlating with a poor outcome following combined cardiac and vascular procedures.
We reviewed 45 consecutive patients undergoing combined cardiac and vascular operations. These included cardiac/CEA (n=27), cardiac/AAA (n=13), cardiac/AAA/one other vascular reconstruction (n=4), and cardiac/renal artery bypass (n=1). Group I included all patients with no morbidity or mortality (n=41) and Group II included patients who died or suffered significant morbidity (stroke, renal failure) (n=4).
Overall mortality was 4.4% (2/45). These two patients underwent cardiac surgery combined with two additional vascular procedures (cardiac/AAA/other). In patients undergoing cardiac/CEA or cardiac/AAA, there were no deaths and one stroke (contralateral to CEA). Group II had significantly decreased ejection fraction (39%+/-6% vs 52%+/-1%) and an increased number of procedures (2.75 vs 2.04).
Combined cardiac surgery and vascular reconstruction can be performed safely. However, multiple vascular reconstructions or the presence of decreased ejection fraction increased operative risk.
本研究旨在确定与心脏和血管联合手术后不良预后相关的因素。
我们回顾了45例连续接受心脏和血管联合手术的患者。这些手术包括心脏/颈动脉内膜切除术（n = 27）、心脏/腹主动脉瘤修复术（n = 13）、心脏/腹主动脉瘤/另一血管重建术（n = 4）以及心脏/肾动脉搭桥术（n = 1）。第一组包括所有无发病或死亡的患者（n = 41），第二组包括死亡或发生严重发病（中风、肾衰竭）的患者（n = 4）。
总体死亡率为4.4%（2/45）。这两名患者接受了心脏手术并额外进行了两种血管手术（心脏/腹主动脉瘤/其他）。在接受心脏/颈动脉内膜切除术或心脏/腹主动脉瘤修复术的患者中，无死亡病例，有1例中风（与颈动脉内膜切除术对侧）。第二组患者的射血分数显著降低（39%±6%对52%±1%），手术数量增加（2.75对2.04）。
心脏手术和血管重建联合手术可以安全进行。然而，多次血管重建或射血分数降低会增加手术风险。
