Pineda Andrés M, Mihos Christos G, Rodriguez-Escudero Juan P, Lamelas Joseph, Beohar Nirat, Santana Orlando
Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA. Electronic correspondence:
Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA.
J Heart Valve Dis. 2017 May;26(3):314-320.
A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than combined median sternotomy coronary artery bypass graft (CABG) and valve surgery.
A retrospective evaluation was made of the outcomes of patients with significant proximal LAD and valvular heart disease undergoing a staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) at the authors' institution between February 2009 and April 2014. A Kaplan-Meier analysis was performed to estimate mid-term survival.
A total of 68 consecutive patients (mean age 75.2 ± 8.9 years) was identified. PCI was performed for one- or two-vessel disease in 76.5% and 23.5% of the patients, respectively. Within a median of 39 days (IQR 11-62 days), 91.2% of patients underwent primary MIVS, and 8.8% underwent re-operative MIVS, of which 58 (85.3%) were single-valve and 10 (14.7%) were double-valve operations. At the time of surgery, 72.1% of the patients were receiving dual anti-platelet therapy. The 30-day mortality was 2.9%. At a mean follow up of 26 ± 16 months, 7.4% of the patients had a non-target vessel acute coronary syndrome, and the survival rate was 88.2%.
Among a select group of patients with proximal LAD and valvular disease, a staged approach of PCI followed by MIVS can be safely performed for primary or re-operative surgery, with excellent mid-term outcomes.
对于一部分需要对左前降支冠状动脉近端（LAD）进行血运重建及瓣膜手术的患者，分期手术可能比同期正中开胸冠状动脉旁路移植术（CABG）联合瓣膜手术更有益。
对2009年2月至2014年4月期间在作者所在机构接受经皮冠状动脉介入治疗（PCI）后行微创瓣膜手术（MIVS）分期手术的严重LAD近端病变和瓣膜性心脏病患者的结局进行回顾性评估。采用Kaplan-Meier分析估计中期生存率。
共纳入68例连续患者（平均年龄75.2±8.9岁）。分别有76.5%和23.5%的患者因单支或双支血管病变接受PCI。在中位时间39天（四分位间距11 - 62天）内，91.2%的患者接受了初次MIVS，8.8%的患者接受了再次手术MIVS，其中58例（85.3%）为单瓣膜手术，10例（14.7%）为双瓣膜手术。手术时，72.1%的患者正在接受双联抗血小板治疗。30天死亡率为2.9%。平均随访26±16个月时，7.4%的患者发生非靶血管急性冠状动脉综合征，生存率为88.2%。
在一组特定的LAD近端病变和瓣膜疾病患者中，PCI后行MIVS的分期手术可安全地用于初次或再次手术，中期结局良好。
