腹主动脉瘤合并冠状动脉疾病的手术策略选择；一期手术与二期手术，非体外循环与体外循环

[Selection of surgical strategy for abdominal aortic aneurysm coexisting with coronary artery disease; one-stage versus two-stage, and off-pump versus on-pump].

作者信息

Endo M, Aomi S, Tomisawa Y, Uchikawa S, Kihara S, Yamasaki K, Nishida H, Kurosawa H

机构信息

Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

出版信息

Kyobu Geka. 2003 Jul;56(8 Suppl):619-25.

PMID:12910939

Abstract

BACKGROUND

In patients having a combination of severe coronary artery disease (CAD) and expanding abdominal aortic aneurysm (AAA), one-stage operation of simultaneous coronary artery bypass grafting (CABG) and AAA repair has been recommended.

METHODS AND RESULTS

Of 96 patients (94 men, average 65 year) with AAA and CAD, 21 patients underwent one-stage operation of simultaneous CABG and AAA repair (Group A-1: off-pump CABG in 10 and on-pump in 11), and 75 underwent two-stage operation of CABG followed by AAA with an interval of less than 6 months in 23 patients (Group A-2) and more than 6 months in 52 patients (Group B). Baseline characteristics were similar between the one-stage and two-stage groups, and off-pump and on-pump subgroups, except the proportion of single vessel disease. Mean number of distal anastomoses was significantly lower in the off-pump subgroup than in the on-pump subgroup (p = 0.011) and the two-stage group (p = 0.0057). There was 1 hospital death among on-pump patients but none among off-pump patients. Mortality rate was 4.8% in the one-stage group. Two patients (8.7 &) in the two-stage group, who had AAA was 7.0 cm and 7.5 cm diameter, died of AAA rupture prior to repair. The 10-year all death free rates were 44% in Group A (A-1 and A-2), and 86% in Group B (p = 0.0004).

CONCLUSIONS

Our data suggest that one-stage operation with off-pump CABG is an attractive option in selected patients with a large AAA (> 7 cm).

摘要

背景

对于患有严重冠状动脉疾病（CAD）和扩张性腹主动脉瘤（AAA）的患者，推荐同时进行冠状动脉旁路移植术（CABG）和AAA修复的一期手术。

方法与结果

在96例患有AAA和CAD的患者（94例男性，平均65岁）中，21例患者接受了CABG和AAA修复的一期手术（A-1组：非体外循环CABG 10例，体外循环11例），75例患者接受了CABG二期手术，随后23例患者（A-2组）在间隔小于6个月时进行AAA修复，52例患者（B组）在间隔大于6个月时进行AAA修复。除单支血管病变比例外，一期和二期组以及非体外循环和体外循环亚组的基线特征相似。非体外循环亚组的平均远端吻合口数量显著低于体外循环亚组（p = 0.011）和二期组（p = 0.0057）。体外循环患者中有1例医院死亡，而非体外循环患者中无死亡。一期组的死亡率为4.8%。二期组中有2例患者（8.7%），其AAA直径分别为7.0 cm和7.5 cm，在修复前死于AAA破裂。A组（A-1和A-2）的10年全因无死亡率为44%，B组为86%（p = 0.0004）。