Macmanus Q, Grunkemeier G, Lambert L, Dietl C, Starr A
J Thorac Cardiovasc Surg. 1978 Jun;75(6):865-9.
The results in 80 patients undergoing simultaneous aortic valve replacement and aorta-coronary saphenous vein bypass grafting were analyzed to assess the effect of operative technique. The over-all operative mortality rate of 6.3% (five of 80) did not differ significantly from our results with aortic valve replacement alone. All patients who had isolated aortic valve replacement were operated upon with moderate hypothermia. The combined operation was performed in two ways. Thirty-one patients had aortic valve replacement prior to bypass grafting with intermittent coronary ostila perfusion. There were two deaths (6.5%), and five myocardial infarctions (16.1%) were diagnosed by standard electrocardiographic and enzyme criteria. More recently, 49 patients have undergone bypass grafting prior to aortic valve replacement. The proximal ends of the grafts were either anastomosed high on the aortic root or else individually cannulated to provide continuous distal perfusion during subsequent aortic valve replacement, with continuous coronary ostial perfusion. There were three operative deaths (6.1%) and one myocardial infarction (2.0%). The risk of combined aortic valve replacement and coronary bypass need be no greater than the risk of aortic valve replacement alone. Our experience suggests that myocardial perfusion distal to significant coronary artery stenoses reduces the risk of myocardial infarction in patients with coronary artery disease requiring aortic valve replacement.
对80例同时接受主动脉瓣置换术和主动脉 - 冠状动脉大隐静脉旁路移植术的患者的结果进行分析，以评估手术技术的效果。总体手术死亡率为6.3%（80例中有5例），与我们单独进行主动脉瓣置换术的结果相比，差异无统计学意义。所有接受单纯主动脉瓣置换术的患者均在中度低温下进行手术。联合手术有两种方式。31例患者在进行旁路移植术之前先进行主动脉瓣置换术，并采用间歇性冠状动脉口灌注。有2例死亡（6.5%），根据标准心电图和酶学标准诊断出5例心肌梗死（16.1%）。最近，49例患者在进行主动脉瓣置换术之前先进行了旁路移植术。移植物的近端要么在主动脉根部较高位置进行吻合，要么单独插管，以便在随后的主动脉瓣置换术期间提供持续的远端灌注，并持续进行冠状动脉口灌注。有3例手术死亡（6.1%）和1例心肌梗死（2.0%）。联合进行主动脉瓣置换术和冠状动脉旁路移植术的风险不一定高于单独进行主动脉瓣置换术的风险。我们的经验表明，对于需要进行主动脉瓣置换术的冠心病患者，在严重冠状动脉狭窄远端进行心肌灌注可降低心肌梗死的风险。
