Byrne John G, Leacche Marzia, Unic Daniel, Rawn James D, Simon Daniel I, Rogers Campbell D, Cohn Lawrence H
Department of Cardiac Surgery, Boston, MA, USA.
J Am Coll Cardiol. 2005 Jan 4;45(1):14-8. doi: 10.1016/j.jacc.2004.09.050.
The goal of this study was to determine if a "hybrid" approach to the treatment of complex combined coronary and valve disease is superior to the results predicted by a Society of Thoracic Surgeons' (STS) algorithm with conventional coronary artery bypass graft (CABG)/valve surgery in high-risk patients.
With advancements in percutaneous coronary interventions (PCIs), some patients requiring coronary revascularization and valve surgery may benefit from a hybrid approach involving initial planned PCI followed by valve surgery, rather than conventional CABG/valve surgery.
We retrospectively analyzed 26 consecutive patients with coronary artery and valve disease who underwent planned initial PCI followed by valve surgery during the same hospital stay between September 1997 and August 2003. We calculated the predicted mortality at the time of PCI and compared it with the observed mortality.
There were 12 male and 14 female patients with a median age of 72 years (range 53 to 91 years). Balloon angioplasty was performed in all patients, followed by stenting in 22 (85%) patients. Within a median of 5 days (range 0 to 14 days), 15 patients (58%) underwent primary and 11 patients (42%) underwent re-operative valve surgery. Operative mortality was 1 of 26 patients (3.8%), dramatically lower than the STS-predicted mortality of 22%. Median blood loss was 900 ml, and 22 patients (85%) required blood transfusions. Survival at 1, 3, and 5 years was 78%, 56%, and 44%, respectively.
Hybrid initial PCI followed by staged valve surgery represents an excellent alternative to conventional CABG/valve surgery in some high-risk patients, particularly those who present in shock after myocardial infarction. Lower mortality rates come at the cost of more bleeding and transfusion requirements.
本研究的目的是确定在高危患者中，治疗复杂的冠状动脉和瓣膜联合疾病的“杂交”方法是否优于胸外科医师协会（STS）算法预测的传统冠状动脉旁路移植术（CABG）/瓣膜手术的结果。
随着经皮冠状动脉介入治疗（PCI）的进展，一些需要冠状动脉血运重建和瓣膜手术的患者可能从涉及初始计划PCI随后进行瓣膜手术的杂交方法中获益，而不是传统的CABG/瓣膜手术。
我们回顾性分析了1997年9月至2003年8月期间在同一住院期间接受计划初始PCI随后进行瓣膜手术的26例连续的冠状动脉和瓣膜疾病患者。我们计算了PCI时的预测死亡率，并将其与观察到的死亡率进行比较。
有12例男性和14例女性患者，中位年龄为72岁（范围53至91岁）。所有患者均进行了球囊血管成形术，随后22例（85%）患者进行了支架置入术。在中位5天（范围0至14天）内，15例患者（58%）接受了初次瓣膜手术，11例患者（42%）接受了再次瓣膜手术。手术死亡率为26例患者中的1例（3.8%），显著低于STS预测的22%的死亡率。中位失血量为900ml，22例患者（85%）需要输血。1年、3年和5年生存率分别为78%、56%和44%。
在一些高危患者中，尤其是心肌梗死后出现休克的患者，杂交初始PCI随后分期进行瓣膜手术是传统CABG/瓣膜手术的极佳替代方案。较低的死亡率是以更多的出血和输血需求为代价的。
