Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China.
BMC Surg. 2022 Oct 13;22(1):359. doi: 10.1186/s12893-022-01805-7.
The surgical strategy among patients with malignancy and coronary artery disease (CAD) remains controversial. In this study, we present the experiences of coronary artery bypass grafting (CABG) in patients with malignancy and analyzed the treatment outcomes.
From January 2011 to October 2021, eight patients combined with coronary artery disease and malignancy, six of them with three-vessel disease and two with anterior descending branch lesions on coronary angiography. The age ranged from 54 to 73 years (61.8 ± 7.7years). Four patients underwent CABG and staging for surgical oncology, and 2 patients underwent CABG and surgical oncology simultaneously. Four patients underwent CABG procedure with cardiopulmonary bypass (on-pump CABG), and the other patients underwent the procedure without cardiopulmonary bypass (off-pump CABG). All patients were followed up for 3 to 96 months (40.4 ± 31.5 months) postoperatively.
The mean number of grafts was 2.6 ± 1.1, there was no in-hospital death, postoperative myocardial infarction, and stroke. Among the eight patients, one patient received chemotherapy and radiation before bypass surgery, which occurred postoperatively pulmonary infection, and the rest of 7 patients had no major adverse cardiovascular events during follow-up periods.
Based on the results of the present study, simultaneous or staged CABG and oncologic surgery according to the TNM stage of the tumor and cardiac assessment is an effective treatment for patients with severe CAD combined with malignancy.
恶性肿瘤合并冠状动脉疾病(CAD)患者的手术策略仍存在争议。本研究介绍了冠状动脉旁路移植术(CABG)治疗恶性肿瘤合并 CAD 患者的经验,并分析了治疗结果。
2011 年 1 月至 2021 年 10 月,8 例合并 CAD 和恶性肿瘤的患者,其中 6 例存在三支血管病变,2 例前降支病变。年龄 54-73 岁(61.8±7.7 岁)。4 例行 CABG 及分期外科肿瘤治疗,2 例行 CABG 及外科肿瘤同期治疗。4 例行体外循环下 CABG(OPCABG),4 例行非体外循环下 CABG(Off-pump CABG)。所有患者术后随访 3-96 个月(40.4±31.5 个月)。
平均移植血管数为 2.6±1.1,无院内死亡、术后心肌梗死和脑卒中。8 例患者中,1 例患者在旁路手术前行化疗和放疗,术后发生肺部感染,其余 7 例患者在随访期间无重大心血管不良事件。
根据本研究结果,根据肿瘤的 TNM 分期和心脏评估,同期或分期 CABG 联合肿瘤外科手术是治疗严重 CAD 合并恶性肿瘤的有效方法。