Barner H B, Naunheim K S, Kanter K R, Fiore A C, McBride L R, Pennington D G, Kaiser G C, Willman V L
Department of Surgery, St. Louis University, MO.
Eur J Cardiothorac Surg. 1988;2(2):106-12. doi: 10.1016/s1010-7940(88)80007-1.
From January 1970 to December 1986, 2.7% (228/8509) of all patients having coronary artery bypass grafting had atherosclerotic coronary ostial stenosis of 50% or more. There were 126 males (55%) and 102 females (45%) with mean ages of 60.2 +/- 9.0 and 59.2 +/- 10.2 years (P = NS), respectively. The left ostium was involved in 176 (77.2%) patients, the right in 41 (18.0%) and both in 11 (4.8%). Isolated ostial stenosis (no associated coronary disease of 50% or more) was present in 38/228 (17%) with females predominating (29/38, 76%). Isolated ostial stenosis occurred more frequently on the right (10/41, 25%) than on the left (18/176, 16%). Associated coronary disease occurred in a single vessel in 42 patients, in two vessels in 72 and in three vessels in 76 resulting in a mean of 2.0 diseased vessels per patient. If patients with isolated ostial stenosis are excluded there were 2.3 diseased arteries per patient. There were 687 grafts performed in these patients, an average of 2.3 grafts per patient. One month surgical mortality was 4.8% (11/228), but has been 2% (2/104) in the last 4 years. Nine of 27 late deaths were noncardiac with a mean follow-up of 49 +/- 44 months. Ostial stenosis is hemodynamically equivalent to left main disease when the left ostium is involved. Symptomatic ostial lesions, whether right or left, require operative therapy.
1970年1月至1986年12月期间，所有接受冠状动脉旁路移植术的患者中，2.7%（228/8509）患有50%或以上的动脉粥样硬化性冠状动脉开口狭窄。男性126例（55%），女性102例（45%），平均年龄分别为60.2±9.0岁和59.2±10.2岁（P=无显著性差异）。左开口受累的患者有176例（77.2%），右开口受累的有41例（18.0%），双侧开口受累的有11例（4.8%）。38/228（17%）存在孤立性开口狭窄（无50%或以上的相关冠状动脉疾病），其中女性居多（29/38，76%）。孤立性开口狭窄在右侧（10/41，25%）比左侧（18/176，16%）更常见。42例患者单支血管存在相关冠状动脉疾病，72例患者两支血管存在相关冠状动脉疾病，76例患者三支血管存在相关冠状动脉疾病，平均每位患者有2.0支病变血管。如果排除孤立性开口狭窄的患者，则每位患者有2.3支病变动脉。这些患者共进行了687次移植，平均每位患者2.3次。术后1个月的手术死亡率为4.8%（11/228），但在过去4年中为2%（2/104）。27例晚期死亡患者中有9例为非心脏原因死亡，平均随访时间为49±44个月。当左开口受累时，开口狭窄在血流动力学上等同于左主干疾病。有症状的开口病变，无论右侧还是左侧，均需要手术治疗。
