Mattila S, Harjula A, Jarvinen A, Kyllonen K E, Tala P
Scand J Thorac Cardiovasc Surg. 1984;18(1):49-52. doi: 10.3109/14017438409099383.
The risk factors involved in simultaneous valve replacement and coronary artery bypass grafting were evaluated in 54 consecutive patients, 42 men and 12 women, aged 22 to 73 years. The predominant valve anomalies were aortic stenosis (30 patients), aortic regurgitation (9), mitral regurgitation (10) and mitral stenosis (5). All the patients had angina. Myocardial infarction had occurred in 22 cases and was impending at the time of operation in 10. The diseased valves were replaced with mechanical prostheses, and on average 2.5 coronary arteries per patient were bypassed with vein or with internal mammary artery grafts. Four of the 54 patients died in association with surgery, and four more during follow-up (0.5-6 years). The operative mortality was 2/39 in the aortic valve group and 2/14 in the mitral valve group. The late mortality was equal in both groups. A relatively small ejection fraction and long aortic cross-clamping were the only factors which attained statistical significance as surgical risks, but mitral regurgitation due to ischaemic papillary muscle dysfunction, advanced rheumatic mitral regurgitation and tight aortic stenosis combined with coronary artery disease also seemed to be indicators of poor prognosis.
对54例连续患者进行了同期瓣膜置换和冠状动脉搭桥术相关危险因素的评估，其中男性42例，女性12例，年龄22至73岁。主要瓣膜异常为主动脉瓣狭窄（30例）、主动脉瓣关闭不全（9例）、二尖瓣关闭不全（10例）和二尖瓣狭窄（5例）。所有患者均有胸痛症状。22例发生过心肌梗死，10例在手术时即将发生心肌梗死。病变瓣膜用机械瓣膜置换，平均每位患者2.5支冠状动脉用静脉或乳内动脉搭桥。54例患者中有4例死于手术相关原因，随访期间（0.5至6年）又有4例死亡。主动脉瓣组手术死亡率为2/39，二尖瓣组为2/14。两组晚期死亡率相同。相对较小的射血分数和较长的主动脉阻断时间是仅有的具有统计学意义的手术风险因素，但缺血性乳头肌功能障碍所致二尖瓣关闭不全、重度风湿性二尖瓣关闭不全以及重度主动脉瓣狭窄合并冠状动脉疾病似乎也是预后不良的指标。
