Sun Li-zhong, Liu Ning-ning, Chang Qian, Zhu Jun-ming, Liu Yong-min, Liu Zhi-gang
Aortic Surgery Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2006 Jan 15;44(2):76-9.
To summarized the experience of simultaneous aortic operation and coronary artery bypass.
Between November 1997 and September 2004, thirty-six patients who underwent combined aortic operation and coronary artery bypass graft (CABG) were reviewed with a mean age of (57 +/- 12) years (range 31 to 75). Nineteen patients were suffered from aortic dissection. There were 17 patients of aortic aneurysm, 5 aortic root aneurysm, 5 ascending aortic aneurysm, 4 aortic arch aneurysm, 3 abdominal aneurysm. Preoperational coronary angiography was performed in 1 of 10 acute type A dissection patients. The coronary arteries were involved by dissection in 7 acute type A dissection patients. The artherosclerosis of coronary artery was found during operation in 2 patients. Among 7 patients with chronic type A aortic dissection, coronary angiography was performed in 2, coronary artery was involved by dissection in 2 and coronary arterosclaerosis was founded in 3. There were 2 patients with acute or chronic type B aortic dissection. The stenosis of coronary artery was confirmed by preoperative angiography in the patients with aortic aneurysm. There were 57 coronary bypass grafts, 6 of them were artery grafts, and others were venous grafts.
The mean cardiopulmonary bypass time was (157 +/- 54) min, and the mean aortic cross clamp time was (98 +/- 31) min. Five patients with type A aortic dissection died postoperatively, 3 from heart failure leading to multi organ system failure, 1 from cerebral hernia and one from ischemia of intestinal tract. Postoperative complication included reoperation for hemorrhage in 1 patient, respiratory failure in 1 patient.
Type A aortic dissection with coronary involvement or arterosclaerosis is associated with high mortality rate. Coronary artery angiography should be performed in the elder than 50 years patient with aortic aneurysm. Combined aortic aneurysm operation and CABG is a safe procedure.
总结同期主动脉手术和冠状动脉搭桥术的经验。
回顾1997年11月至2004年9月期间36例行主动脉手术联合冠状动脉搭桥术（CABG）的患者，平均年龄（57±12）岁（范围31至75岁）。19例患者患有主动脉夹层。有17例主动脉瘤患者，其中5例为主动脉根部瘤，5例为升主动脉瘤，4例为主动脉弓瘤，3例为腹主动脉瘤。10例急性A型夹层患者中有1例行术前冠状动脉造影。7例急性A型夹层患者冠状动脉受夹层累及。术中发现2例患者有冠状动脉粥样硬化。7例慢性A型主动脉夹层患者中，2例行冠状动脉造影，2例冠状动脉受夹层累及，3例有冠状动脉粥样硬化。有2例急性或慢性B型主动脉夹层患者。主动脉瘤患者术前血管造影证实有冠状动脉狭窄。共进行了57次冠状动脉搭桥，其中6次为动脉搭桥，其余为静脉搭桥。
平均体外循环时间为（157±54）分钟，平均主动脉阻断时间为（98±31）分钟。5例A型主动脉夹层患者术后死亡，3例死于心力衰竭导致多器官系统衰竭，1例死于脑疝，1例死于肠道缺血。术后并发症包括1例因出血再次手术，1例呼吸衰竭。
合并冠状动脉受累或粥样硬化的A型主动脉夹层死亡率高。50岁以上的主动脉瘤患者应行冠状动脉造影。主动脉瘤手术联合CABG是一种安全的手术。
