Venugopal P, Das B, Sharma M L, Kumar A S, Saxena N, Kaul U
Indian Heart J. 1989 May-Jun;41(3):153-7.
During a follow up period of 5 years (January 1983-December 1988), 145 consecutive patients (14% of all patients undergoing coronary artery bypass surgery) underwent multiple coronary artery bypass grafting combined with endarterectomy whenever necessary for treatment of severe diffuse triple-vessel coronary artery disease. Fifty-one patients (35%) had poor left ventricular ejection fraction (less than 35%). Associated left main coronary artery disease was present in 30 (21%) patients. All coronary arteries and branches with greater than 50% obstructive disease were bypassed, using saphenous vein conduit; average grafts per patient were 5.5. Endarterectomies were done in 137 patients in 210 vessels. Right coronary artery was the commonest site (132 patients). Multiple vessel endarterectomy (greater than 2 vessels) was done in 44 patients (30%). The peri-operative mortality was 3.5%. Pre-operatively, 75% patients had class III and 14% class IV (Canadian Cardiovascular Society angina criteria). During the mean follow up period of 2 years, 86% patients have class 1 symptoms, and 14% have class II symptom. Thirty of these 145 patients have undergone resting and exercise radionuclide ventriculographic studies which have shown a significant improvement in the ejection fraction response to exercise (p less than 0.05). Thus, patients with severe diffuse coronary disease can undergo multiple bypass grafting procedure, along with endarterectomies with low mortality rates and improved exercise tolerance and functional classification.
在1983年1月至1988年12月的5年随访期内，145例连续患者（占所有接受冠状动脉搭桥手术患者的14%）接受了多支冠状动脉搭桥术，并在必要时联合内膜切除术，以治疗严重弥漫性三支冠状动脉疾病。51例患者（35%）左心室射血分数较低（低于35%）。30例患者（21%）存在左主干冠状动脉疾病。所有狭窄程度大于50%的冠状动脉及其分支均采用大隐静脉导管进行搭桥；每位患者平均搭桥5.5支。137例患者的210支血管进行了内膜切除术。右冠状动脉是最常见的部位（132例患者）。44例患者（30%）进行了多支血管内膜切除术（超过2支血管）。围手术期死亡率为3.5%。术前，75%的患者为III级，14%为IV级（加拿大心血管学会心绞痛标准）。在平均2年的随访期内，86%的患者症状为I级，14%为II级。这145例患者中有30例接受了静息和运动放射性核素心室造影研究，结果显示运动时射血分数反应有显著改善（p<0.05）。因此，患有严重弥漫性冠状动脉疾病的患者可以接受多支搭桥手术，同时进行内膜切除术，死亡率较低，运动耐量和功能分级得到改善。
