Kumar Sanjay, Agarwala Sandeep, Talbot Charlie, Nair R Unnikrishnan
Department of Cardiothoracic surgery, Yorkshire heart Centre, Leeds General Infirmary, Leeds, UK.
J Cardiothorac Surg. 2008 Mar 26;3:15. doi: 10.1186/1749-8090-3-15.
Coronary Endarterectomy (CE) in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. There are no published data on its role and benefit in patients undergoing more complex operations. We present our experience with CE in patients undergoing valve surgery with concomitant CABG.
Between 1989 and 2003, 237 patients underwent CABG with valve surgery under a single surgeon at our institution. Of these, 41 patients needed CE. Data was retrospectively obtained from hospital records and database. Further follow-up was obtained by telephone interview. All variables were analyzed by univariate analysis for significant factors relating to hospital mortality. Morbidity and long term survival was also studied. There were 29 males and 12 females with a mean age of 67.4 +/- 8.1 and body mass index of 26.3 +/- 3.3. Their mean euroscore was 7.6 +/- 3.2 and the log euro score was 12.2 +/- 16.1.
Thirty-two patients were discharged from the intensive therapy unit within 48 hours after surgery. Average hospital stay was 12.7 +/- 10.43 days. Thirty day mortality was 9.8%. Six late deaths occurred during the 14 year follow up. Ten year survival was 57.2% (95% CL 37.8%-86.6%). Three of the survivors had Class II symptoms, with one requiring nitrates. None required further percutaneous or surgical intervention. We compared the result with the available mortality figure from the SCTS database.
Compared to the SCTS database for these patients, we have observed that CE does not increase the mortality in combined procedures. By accomplishing revascularization in areas deemed ungraftable, we have shown an added survival benefit in this group of patients.
对于接受冠状动脉旁路移植术（CABG）的患者，冠状动脉内膜切除术（CE）已被证明对患有弥漫性冠状动脉疾病的患者有益。目前尚无关于其在接受更复杂手术的患者中的作用和益处的公开数据。我们介绍了在接受瓣膜手术并同期进行CABG的患者中进行CE的经验。
1989年至2003年期间，我们机构的一名外科医生为237例患者进行了CABG联合瓣膜手术。其中，41例患者需要进行CE。数据通过回顾性从医院记录和数据库中获取。通过电话访谈获得进一步随访。对所有变量进行单因素分析，以确定与医院死亡率相关的显著因素。还研究了发病率和长期生存率。患者中有29名男性和12名女性，平均年龄为67.4±8.1岁，体重指数为26.3±3.3。他们的平均欧洲心脏手术风险评估系统（EuroSCORE）评分为7.6±3.2，对数EuroSCORE评分为12.2±16.1。
32例患者在术后48小时内从重症监护病房出院。平均住院时间为12.7±10.43天。30天死亡率为9.8%。在14年的随访期间发生了6例晚期死亡。10年生存率为57.2%（95%可信区间37.8%-86.6%）。三名幸存者有II级症状，其中一人需要使用硝酸盐类药物。无人需要进一步的经皮或手术干预。我们将结果与心脏学会胸外科医师协会（SCTS）数据库中的现有死亡率数据进行了比较。
与这些患者的SCTS数据库相比，我们观察到CE在联合手术中不会增加死亡率。通过在被认为无法进行移植的区域实现血运重建，我们在这组患者中显示出额外的生存益处。
