Hvass U, de Brux J L, Panes F, Pansard Y, Boehm G, Langlois J
Service de chirurgie cardiovasculaire, hôpital Bichat, Paris.
Arch Mal Coeur Vaiss. 1991 Jan;84(1):77-80.
One hundred consecutive patients aged 71 to 80 without other cardiac pathology underwent coronary bypass surgery by the same surgical team between January 1986 and May 1989. These patients were recruited from a group of 687 patients undergoing coronary bypass surgery in the same period. The indication was always based on the severity of clinical symptoms resistant to medical therapy. Recent unstable angina despite triple therapy was a particularly common indication in this group of patients (61%). Preoperative coronary angiography showed a high incidence of triple vessel (62 cases) and left main stem disease (23 cases). Double vessel (12 cases) and single vessel disease (3 cases) were less common. Preoperative myocardial infarction was observed in 35% of cases; the site was nearly always on the inferior wall. In all, 230 bypasses were performed including 23 internal mammary artery bypasses (average 2.3 bypasses per patient). Six patients developed perioperative myocardial infarction confirmed by ECG and a rise in cardiac enzymes in 4 cases and by a rise in the cardiac enzymes alone in 2 cases. The mortality was low in this group of patients (3%). This was due to strict selection of patients in this age group and also to the improvement in the techniques of myocardial protection, anaesthesia and intensive care. Our results justify the operative indications in this group of patients in whom medical therapy has failed.
1986年1月至1989年5月期间，同一手术团队为100例年龄在71岁至80岁之间、无其他心脏病变的患者进行了冠状动脉搭桥手术。这些患者是从同期接受冠状动脉搭桥手术的687例患者中挑选出来的。手术指征始终基于对药物治疗无效的临床症状的严重程度。尽管进行了三联治疗仍有近期不稳定型心绞痛，在这组患者中是一个特别常见的指征（61%）。术前冠状动脉造影显示三支血管病变（62例）和左主干病变（23例）的发生率很高。双支血管病变（12例）和单支血管病变（3例）较少见。35%的病例术前观察到心肌梗死；梗死部位几乎总是在下壁。总共进行了230次搭桥手术，包括23次乳内动脉搭桥手术（平均每位患者2.3次搭桥）。6例患者发生围手术期心肌梗死，4例经心电图和心肌酶升高证实，2例仅经心肌酶升高证实。这组患者的死亡率较低（3%）。这归因于对该年龄组患者的严格选择，以及心肌保护、麻醉和重症监护技术的改进。我们的结果证明了对这组药物治疗无效的患者进行手术治疗的指征是合理的。
