Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
Ann Thorac Surg. 2014 Jun;97(6):2049-55. doi: 10.1016/j.athoracsur.2014.02.039. Epub 2014 Apr 13.
A subset of patients requiring coronary revascularization and valve operations may benefit from a hybrid approach of percutaneous coronary intervention (PCI) followed by a minimally invasive valve operation, rather than the standard combined median sternotomy coronary artery bypass grafting (CABG) and a valve operation. This study sought to evaluate the outcomes of this approach in a heterogeneous group of patients with concomitant coronary artery and valvular disease.
We retrospectively evaluated 222 consecutive patients with coronary artery and valvular heart disease who underwent PCI followed by elective minimally invasive valve operations at our institution between February 2009 and August 2013.
A total of 136 men and 86 women were identified. The mean age was 74.6 ± 8.2 years, with 181 (81.5%) undergoing 1-vessel, 27 (12.2%) undergoing 2-vessel, and 14 (6.3%) undergoing 3-vessel PCI. Within a median of 38 days (interquartile range [IQR] 18-65 days), 182 (82%) patients underwent primary and 34 (15.3%) underwent repeated valve operations, which consisted of 185 (83.3%) single-valve and 37 (16.7%) double-valve procedures. Operative mortality occurred in 8 patients (3.6%). At a mean follow-up of 16.2 ± 12 months, 6 patients required PCI, with target-vessel revascularization performed in 4 patients (2.1%). Survival at 1 and 4.5 years was 91.9% and 88.3%, respectively.
In a heterogeneous group of patients, a hybrid approach of PCI followed by minimally invasive valve operations in patients undergoing primary or repeated valve operations can be performed with excellent outcomes.
需要进行冠状动脉血运重建和瓣膜手术的患者亚组可能受益于经皮冠状动脉介入治疗（PCI）后行微创瓣膜手术的杂交方法，而不是标准的正中胸骨切开冠状动脉旁路移植术（CABG）和瓣膜手术联合治疗。本研究旨在评估该方法在伴有冠状动脉和瓣膜疾病的异质患者群体中的结果。
我们回顾性评估了 2009 年 2 月至 2013 年 8 月期间在我院行 PCI 后择期行微创瓣膜手术的 222 例连续冠状动脉和瓣膜心脏病患者。
共确定了 136 名男性和 86 名女性。平均年龄为 74.6±8.2 岁，其中 181 例（81.5%）行 1 支血管 PCI，27 例（12.2%）行 2 支血管 PCI，14 例（6.3%）行 3 支血管 PCI。中位数为 38 天（IQR 18-65 天）内，182 例（82%）患者行初次瓣膜手术，34 例（15.3%）患者行再次瓣膜手术，其中 185 例（83.3%）行单瓣膜手术，37 例（16.7%）行双瓣膜手术。8 例（3.6%）患者发生手术死亡。平均随访 16.2±12 个月时，6 例患者需要 PCI，4 例患者（2.1%）行靶血管血运重建。1 年和 4.5 年的生存率分别为 91.9%和 88.3%。
在异质患者群体中，经皮冠状动脉介入治疗后行微创瓣膜手术的杂交方法可用于行初次或再次瓣膜手术的患者，可获得良好的结果。
