Ogino H, Ueda Y, Tahata T, Sugita T, Nishizawa J, Matsuyama K, Yoshimura S, Yoshioka T, Tokuda Y
Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan.
Jpn J Thorac Cardiovasc Surg. 2001 Apr;49(4):195-200. doi: 10.1007/BF02913515.
We review the outcome of coronary artery bypass grafting in patients with a severe atherosclerotic ascending aorta.
Subjects were 31 patients averaging 69.4 +/- 6.9 years old studied from 1990 through 1998. Ascending aortic lesions were assessed using epiaortic echo and 2 types of aortic nonclamping techniques applied. In 29 patients operated on in the early years, bypass grafting was conducted on the hypothermic fibrillated heart in 22 and on the beating heart in 7. The remaining 2 underwent off-pump coronary artery bypass grafting more recently. For cases with multivessel disease, we used composite grafting.
Three patients developed mild stroke and 5 died within 30 days of surgery--4 from multiple emboli (1 accompanied by a stroke) and 1 from perioperative myocardial infarction. One hospital death occurred due to brain damage and multiorgan failure following unexpected rupture of a saphenous vein graft. No cardiac deaths occurred in the late stage of our series. Actuarial survival was 73.0% for 3 years and 68.0% for 5 years. Freedom from cardiac events was favorable in the remaining 25 survivors.
Outcome was suboptimal for the risks involved. Recent technical advances, including coronary surgery on the beating heart with or without cardiopulmonary bypass using variable in-situ or free arterial grafts, associated with adequate evaluation of systemic atherosclerosis, should improve this outcome.
我们回顾了严重动脉粥样硬化性升主动脉患者冠状动脉搭桥术的结果。
研究对象为1990年至1998年期间研究的31例患者，平均年龄69.4±6.9岁。使用主动脉外膜超声评估升主动脉病变，并应用两种类型的主动脉不阻断技术。在早年接受手术的29例患者中，22例在低温颤动心脏上进行搭桥手术，7例在跳动心脏上进行。其余2例最近接受了非体外循环冠状动脉搭桥术。对于多支血管病变的病例，我们采用了复合移植术。
3例患者发生轻度中风，5例在术后30天内死亡——4例死于多发性栓塞（1例伴有中风），1例死于围手术期心肌梗死。1例医院死亡是由于大隐静脉移植意外破裂后发生脑损伤和多器官功能衰竭。在我们的系列研究后期没有发生心脏死亡。3年的精算生存率为73.0%，5年为68.0%。其余25名幸存者的心脏事件发生率较低。
就所涉及的风险而言，结果并不理想。包括使用可变原位或游离动脉移植物在有或无体外循环的跳动心脏上进行冠状动脉手术在内的最新技术进展，结合对全身性动脉粥样硬化的充分评估，应能改善这一结果。
