Kaul T K, Agnihotri A K, Fields B L, Riggins L S, Wyatt D A, Jones C R
Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL 35211, USA.
J Thorac Cardiovasc Surg. 1996 May;111(5):1001-12. doi: 10.1016/s0022-5223(96)70377-x.
Over a 7-year period, 5.8% (n = 210) of patients who underwent coronary artery bypass grafting at our institution had severely impaired global left ventricular function with an ejection fraction of 20% or less. Mean age at operation was 66 years (+/- 0.7; standard error), and 76% of patients were male. Primary indications for operation were unstable angina (73 patients, 35%), return of symptoms with previous bypass grafting (41 patients, 20%), congestive heart failure with reversible ischemia (55 patients, 26%), and recurrent ventricular arrhythmias (41 patients, 20%). Overall, actuarial survival (n = 210) was 82%, 79%, and 73% at 1, 2, and 5 years. Risk of death was highest early after the operation, and then declined rapidly to a constant level. Patients who did not receive retrograde coronary sinus cardioplegia (p = 0.05), older patients (p = 0.004), and those with preoperative ventricular arrhythmias (p = 0.003) or renal failure (p < 0.0001) had an increased risk of death early after operation. Patients with congestive symptoms and those requiring extensive or redo bypass grafting (p = 0.02) were found to be at an increased risk of death throughout the follow-up period. When the number of distal anastomoses performed increased, survival was found to decrease (p < 0.003), and to a greater extent in women than in men (p = 0.02). Of the four primary indications for operation, unstable angina yielded the highest risk-adjusted survival. Successful results after surgical revascularization in patients with severe impairment of ventricular function can be achieved by careful patient selection and management.
在7年期间，在我们机构接受冠状动脉搭桥手术的患者中，5.8%（n = 210）的患者左心室整体功能严重受损，射血分数为20%或更低。手术时的平均年龄为66岁（±0.7；标准误），76%的患者为男性。手术的主要指征为不稳定型心绞痛（73例患者，35%）、既往搭桥手术后症状复发（41例患者，20%）、伴有可逆性缺血的充血性心力衰竭（55例患者，26%）以及复发性室性心律失常（41例患者，20%）。总体而言，210例患者的1年、2年和5年精算生存率分别为82%、79%和73%。死亡风险在术后早期最高，然后迅速下降至稳定水平。未接受逆行冠状静脉窦停搏的患者（p = 0.05）、老年患者（p = 0.004）以及术前有室性心律失常（p = 0.003）或肾衰竭（p < 0.0001）的患者术后早期死亡风险增加。有充血症状的患者以及需要进行广泛或再次搭桥手术的患者（p = 0.02）在整个随访期间死亡风险增加。当进行的远端吻合数量增加时，生存率下降（p < 0.003），且女性下降幅度大于男性（p = 0.02）。在四个主要手术指征中，不稳定型心绞痛的风险调整后生存率最高。通过仔细的患者选择和管理，可以在心室功能严重受损的患者中实现手术血运重建的成功结果。
