Surgical treatment for left main coronary artery stenosis in patients of advanced age

中华老年医学杂志 Pub Date : 2020-01-14 DOI:10.3760/CMA.J.ISSN.0254-9026.2020.01.009

Ming-yang Zhou, Xiubin Yang, K. Hua, B. Mao, Liang Zhang

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Abstract

Objective To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD). Methods From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG. Results The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality. Conclusions Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments. Key words: Coronary disease; Coronary artery bypass, off-pump

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高龄患者左主干冠状动脉狭窄的外科治疗

目的分析高龄左主干冠状动脉病变(LMCAD)患者行冠状动脉旁路移植术(CABG)的临床疗效。方法2005 ~ 2014年，我院101例≥80岁老年LMCAD患者行非体外循环冠脉搭桥。其中男性82例，女性19例，平均年龄(81.4±1.7)岁。左主干明显狭窄76例(75.2%)(≥70%)，左主干狭窄小于70% 25例。左室舒张末期平均直径为(48.2±8.3)cm;左室射血分数≥50% 89例，30% ~ 50% 12例。二尖瓣功能不全14例，室性动脉瘤1例。此外，56例患者具有纽约心脏协会功能分类Ⅰ至Ⅱ，45例患者具有Ⅲ至Ⅳ分类。99例患者为加拿大血管学会(CCS)心绞痛分级Ⅰ~Ⅲ，2例为分级Ⅳ，13例为急性心肌梗死。6例患者在冠脉搭桥前植入主动脉内球囊反搏。结果平均手术时间(3.9±0.8)h，平均桥血管数(3.0±1.0)根，ICU监护时间(50.2±46.0)h，呼吸机辅助呼吸时间(42.9±68.5)h。二次开胸止血6例(5.9%)，二次气管插管5例(4.9%)，持续透析4例(4.0%)。术中植入主动脉内气囊反搏3例(2.9%)，术后植入11例(10.9%)。围术期心肌梗死2例(2.0%)，术后死亡8例(7.9%)。中位随访时间为6(1-11)年，全因死亡率为17例(16.8%)。结论虽然老年和左主干狭窄这两个独立的高危因素经常并存，但非体外循环冠脉搭桥及围手术期管理仍然是安全有效的治疗方法。关键词:冠心病;冠状动脉搭桥，非体外循环

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中华老年医学杂志

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