同期颈动脉内膜切除术和非体外循环冠状动脉旁路移植术治疗合并颈动脉和冠状动脉疾病患者的初步结果。

Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases.

机构信息

Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210006, China.

出版信息

Chin Med J (Engl). 2009 Dec 20;122(24):2951-5.

PMID:20137480

Abstract

BACKGROUND

Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.

METHODS

Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out.

RESULTS

A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5 +/- 7.0) minutes. The mean number of distal grafts per patient was 3.30 +/- 0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3 +/- 5.4) hours, (2.1 +/- 0.9) days, and (12.5 +/- 6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5 +/- 12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.

CONCLUSION

Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

摘要

背景

同时存在颈动脉和冠状动脉疾病较为常见，这些患者在接受冠状动脉旁路移植手术后仍存在围手术期中风或心肌梗死的高风险。本研究旨在探讨同期行颈动脉内膜切除术（CEA）和非体外循环冠状动脉旁路移植术（CABG）治疗同时存在颈动脉和冠状动脉疾病的效果。

方法

2002 年 1 月至 2007 年 12 月，南京医科大学第一附属医院心脏科连续收治了 51 例同时患有颈动脉和冠状动脉疾病的患者，行单侧同期 CEA 和非体外循环 CABG。评估围手术期并发症并进行随访。

结果

共进行了 51 例单纯非体外循环 CABG 和单侧 CEA 手术，其中右侧 34 例，左侧 17 例。CEA 中颈动脉阻断时间平均为（25.5±7.0）分钟。每位患者的远端吻合支平均数量为 3.30±0.45。平均通气时间、重症监护病房停留时间和术后住院时间分别为（11.3±5.4）小时、（2.1±0.9）天和（12.5±6.1）天。无患者发生中风或心肌梗死。1 例患者因急性心力衰竭围手术期死亡，手术死亡率为 1.96%。47 例患者（92.16%）完成随访，平均随访时间（39.5±12.5）个月。无患者出现中风、新发心绞痛或新发生心肌梗死。无晚期死亡。