Haxhibeqiri-Karabdic Ilirijana, Hasanovic Aida, Kabil Emir, Straus Slavenka
Heart Center, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
Department of Anatomy, Faculty of medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Med Arch. 2014 Oct;68(5):332-4. doi: 10.5455/medarh.2014.68.332-334. Epub 2014 Oct 15.
The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life.
Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients.
Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days.
In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction.
本研究评估我们在左心室（LV）严重功能障碍和低射血分数-EF（<35%）患者中进行主动脉冠状动脉搭桥术的经验。由于对发病率、死亡率和生活质量的担忧，在这种情况下心肌血运重建仍然存在争议。
40例患有严重冠状动脉疾病和左心室功能障碍（低射血分数<35%）的患者在3年期间接受了冠状动脉搭桥术。40例患者的术前诊断包括病史、临床检查、非侵入性方法EHO、MR以及侵入性诊断方法——导管插入术。手术的主要指征是严重心绞痛、心力衰竭症状和低射血分数。所有手术患者均使用了乳内动脉。
接受手术患者的平均年龄为59.8岁。在本研究中，男性占81.3%，女性占18.8%。我们发现2.5%（1/40）的患者存在单支血管病变，40%（16/40）的患者存在双支血管病变，42.5%（17/40）的患者存在三支血管病变，15%（6/40）的患者存在四支血管病变。2.5%的患者植入了1条旁路移植血管，42.5%的患者植入了2条旁路移植血管，45.5%的患者植入了3条旁路移植血管，10%的患者植入了4条旁路移植血管。术前评估的左心室射血分数为18%-27%，术后30天内提高到了31.08%。
对于左心室功能障碍患者，冠状动脉搭桥术可以安全进行，生活质量和左心室射血分数均可得到改善。
