Levy R D, Bennett D H, Brooks N H
Regional Cardiothoracic Unit, Wythenshawe Hospital, Manchester.
Br Heart J. 1991 Feb;65(2):68-71. doi: 10.1136/hrt.65.2.68.
To assess the value of emergency surgical standby for percutaneous transluminal coronary angioplasty.
Retrospective review of the major complications of coronary angioplasty in a regional cardiac centre.
All angioplasties were performed in the cardiac catheterisation laboratory of Wythenshawe Hospital with surgical standby in an adjoining operating theatre.
1262 vessels were dilated in 1032 patients (mean age 53 years) between 1984 and 1989.
In-hospital mortality from emergency surgical revascularisation after angioplasty; the rate of myocardial infarction and overall morbidity.
Coronary angioplasty achieved primary success in 90% of cases. Thirty eight (3.7%) patients (five women (mean age 55.8) and 33 men (mean age 53.0] were referred for urgent surgical revascularisation--36 direct to operation and two within 24 hours. All patients survived surgery. Five of the 38 had had a previous angioplasty to the same vessel and one had had previous coronary artery grafts. Four of the 38 had an angioplasty for unstable angina. Eighteen had single, 13 double, and seven triple vessel coronary artery disease. The target vessel was the left anterior descending in 25, right coronary artery in nine, circumflex in three, and the left anterior descending and circumflex coronary arteries in one. Five required external cardiac massage on the way to the operating theatre; two of them had a left main stem occlusion. Four internal mammary artery and 60 reversed saphenous vein grafts were implanted (1.6 per patient). Complete revascularisation was achieved in 36 (94.7%) patients. Q wave myocardial infarction occurred in six (15.8%). The final outcome was: none dead, three patients with angina, one late death, one cerebrovascular accident, one late operation for a new left anterior descending lesion, two patients on diuretics with or without an angiotensin converting enzyme inhibitor. One orthotopic transplant was performed in a patient in whom cardiogenic shock developed after the left anterior descending coronary artery became occluded 72 hours after angioplasty.
There was no surgical mortality and low morbidity among patients for whom immediate surgical cover was requested.
评估急诊手术备用方案在经皮腔内冠状动脉成形术中的价值。
对某地区心脏中心冠状动脉成形术的主要并发症进行回顾性研究。
所有血管成形术均在怀滕肖医院的心导管实验室进行，旁边的手术室有手术备用。
1984年至1989年间，对1032例患者（平均年龄53岁）的1262条血管进行了扩张。
血管成形术后急诊手术血运重建的院内死亡率；心肌梗死发生率和总体发病率。
冠状动脉成形术90%的病例获得初步成功。38例（3.7%）患者（5名女性（平均年龄55.8岁）和33名男性（平均年龄53.0岁））被转诊进行紧急手术血运重建——其中36例直接进行手术，2例在24小时内进行。所有患者手术存活。38例中有5例之前对同一血管进行过血管成形术，1例之前接受过冠状动脉搭桥术。38例中有4例因不稳定型心绞痛接受血管成形术。18例为单支血管、13例为双支血管、7例为三支血管冠状动脉疾病。目标血管为左前降支25例、右冠状动脉9例、回旋支3例、左前降支和回旋支冠状动脉1例。5例在前往手术室途中需要进行体外心脏按压；其中2例为左主干闭塞。植入了4条胸廓内动脉和60条大隐静脉反转移植血管（每位患者1.6条）。36例（94.7%）患者实现了完全血运重建。6例（15.8%）发生Q波心肌梗死。最终结果为：无死亡病例，3例患者有胸痛症状，1例晚期死亡，1例脑血管意外，1例因新的左前降支病变进行晚期手术，2例患者使用利尿剂，可使用或不使用血管紧张素转换酶抑制剂。1例患者在血管成形术72小时后左前降支冠状动脉闭塞并发心源性休克，接受了原位心脏移植。
对于要求立即进行手术保障的患者，手术死亡率低且发病率低。
