Machraoui A, Purucker H C, Jäger D, Lemke B, von Dryander S, Barmeyer J
Abteilung für Kardiologie und Angiologic, Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum-Universitätsklinik.
Med Klin (Munich). 1995 Jan 15;90(1):17-22.
The extent of myocardial revascularisation by aortocoronary bypass surgery can only be quantitatively evaluated by using precise criteria. In this retrospective study the effect of coronary surgery on left ventricular function was analyzed.
In 161 patients, 148 male and 13 female, aged 52.5 +/- 7.0 years (33 to 69 years) with 1 (7%), 2 (38%) or 3 vessel disease (55%) the left ventricular function was analyzed by Swan-Ganz catheterization at rest and on exercise, five months before and after coronary bypass operation. Coronary artery and bypass lesions were quantified according to a new detailed score including diseased main or side branches, segment 1 to 3, type of irrigation and area reduction of the artery cross-section. Pulmonary capillary wedge pressure and cardiac index were measured and related to the grade of revascularisation (RG) and pre-operative ejection fraction (EF), classified in the groups RG1 < 50%, n = 54; RG2 50 to 74%, n = 52; RG3 > or = 75%, n = 55, EF1 < 60%, n = 30 and EF2 > or = 60%, n = 129.
The change in pulmonary capillary wedge pressure on exercise was in RG1, RG2 and RG3 -26.2%, -29.0% and -40.9%, respectively (p < 0.001). It was significantly higher in RG2 and RG3 than in RG1. The increase in cardiac index on exercise was significant only in groups RG2, RG3 and EF2 (p < 0.005).
Adequate improvement of left ventricular function can be expected when a grade of revascularisation of 50% and more is achieved.
只有采用精确的标准才能对主动脉冠状动脉搭桥手术实现的心肌血运重建程度进行定量评估。在这项回顾性研究中，分析了冠状动脉手术对左心室功能的影响。
对161例患者（148例男性，13例女性，年龄52.5±7.0岁，33至69岁）进行研究，这些患者患有单支血管病变（7%）、双支血管病变（38%）或三支血管病变（55%），在冠状动脉搭桥手术前后五个月，通过Swan-Ganz导管插入术在静息和运动状态下分析其左心室功能。根据一项新的详细评分对冠状动脉和搭桥病变进行量化，该评分包括病变的主要或分支血管、1至3段、灌注类型以及动脉横截面的面积减少情况。测量肺毛细血管楔压和心脏指数，并将其与血运重建等级（RG）和术前射血分数（EF）相关联，将患者分为以下几组：RG1<50%，n = 54；RG2为50至74%，n = 52；RG3≥75%，n = 55，EF1<60%，n = 30以及EF2≥60%，n = 129。
运动时肺毛细血管楔压的变化在RG1、RG2和RG3组中分别为-26.2%、-29.0%和-40.9%（p<0.001）。RG2和RG3组明显高于RG1组。运动时心脏指数的增加仅在RG2、RG3组和EF2组中具有统计学意义（p<0.005）。
当血运重建等级达到50%及以上时，可以预期左心室功能会得到充分改善。
