Lytle B W
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio.
Cardiol Clin. 1991 May;9(2):301-14.
Patients who undergo coronary bypass grafting in association with aortic valve replacement currently have a low in-hospital mortality, but their late survival is inferior to that of patients without coronary disease who undergo isolated aortic valve replacement. Patients who receive porcine heterografts to replace the aortic valve have better late survival and event-free survival after aortic valve replacement combined with bypass grafting than those who received mechanical valves. The analyses of patients who combine coronary artery and mitral valve disease is difficult because of changing surgical practices and diagnostic techniques. Patients undergoing surgery for mitral valve replacement combined with bypass grafting have had higher in-hospital mortality and worse late survival than patients undergoing aortic valve replacement combined with bypass grafting. The increased use of techniques for reconstructing rather than replacing the mitral valve may help improve the long-term results for patients undergoing surgery for mitral valve dysfunction combined with coronary disease.
目前，接受冠状动脉搭桥术联合主动脉瓣置换术的患者院内死亡率较低，但其远期生存率低于接受单纯主动脉瓣置换术的无冠心病患者。接受猪异种移植物置换主动脉瓣的患者，在主动脉瓣置换联合搭桥术后的远期生存率和无事件生存率优于接受机械瓣膜的患者。由于手术方式和诊断技术不断变化，对合并冠状动脉和二尖瓣疾病患者的分析存在困难。接受二尖瓣置换联合搭桥术的患者，其院内死亡率高于接受主动脉瓣置换联合搭桥术的患者，远期生存率也更差。增加二尖瓣重建而非置换技术的应用，可能有助于改善合并冠心病的二尖瓣功能障碍患者手术的长期效果。
