• 中國醫(yī)學科學院北京協和醫(yī)學院阜外心血管病醫(yī)院心血管病研究所外科,北京 100037;

目的  觀察“一站式”復合技術治療冠狀動脈多支病變患者的早中期隨訪結果。方法  2007年 6月 至 2009年 12月共 104例冠狀動脈多支病變患者在阜外心血管病醫(yī)院接受“一站式”復合技術再血管化治療,其中男 93例 ,女 11例;年齡 35~81(61.8±10.2)歲。所有患者均為包括左前降支( left anterior descending,LAD)病變在內的多支病變?!耙徽臼健睆秃霞夹g要點為:胸骨下段小切口左側第 2肋間橫斷胸骨,心臟不停跳完成左乳內動脈(left internal mammary artery,LIMA)至 LAD吻合,關胸后立即造影確定 LAD血運重建滿意后即經胃管給予波立維300 mg,靜脈肝素化[全血激活凝血時間( ACT)>250 s],行經皮冠狀動脈介入(percutaneous coronary intervention,PCI)治療其他非前降支狹窄病變。結果  本組患者均順利施行“一站式”復合技術再血管化治療,全部行 LIMA至 LAD血管移植,植入藥物支架 191枚,裸金屬支架 3枚;全組無手術及院內死亡。所有患者均獲得隨訪,平均隨訪 1.5年,其中 1例出現支架狹窄,再次接受介入治療;全組無心肌梗死發(fā)生,無腦血管事件及死亡患者。結論  “一站式”復合技術再血管化是治療多支冠狀動脈粥樣硬化心臟病的一種安全有效的選擇。

引用本文: 王浩然,胡盛壽,徐波等. “一站式”復合技術治療冠狀動脈多支病變患者早中期隨訪結果. 中國胸心血管外科臨床雜志, 2012, 19(3): 232-234. doi: 復制

1. Circulation, 2004, 13 (11):54-55.
2. J Med, 2008, 358 (4):331-341.
3.  Angelini GD, Wilde P, Salerno TA, et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet,1996, 347 (9003):757-758.
4.  Amodeo VJ, Donias HW, Dancona G, et al. The hybrid approach to coronary artery revascularization:minimally invasive direct coronary artery bypass with percutaneous coronary intervention. Angiology, 2002, 53 (6):665-669.
5.  Wittwer T, Cremer J, Boonstra P, et al. Myocardial“hybrid” revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty:preliminary results of a multicentre study. Heart, 2000, 83 (1):58-63.
6.  Bonaros N, Schachner T, Wiedemann D, et al. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and techniques from a two-center experience. Eur J Cardiothorac Surg, 2011, 40 (4):783-787.
7.  Bravata DM,Gienger AL, Mcdonald KM, et al. Systematic review:the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med, 2007, 147 (10):703-716.
8.  BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol, 2007, 49 (15):1600-1606.
9.  Kim KB, Cho KR, Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass:serial comparison using early, 1-year, and 5-year postoperative angiograms. J Thorac Cardiovasc Surg, 2008, 135 (2):300-307.
10.  Hayward PA, Buxton BF. Contemporary coronary graft patency:5-year observational data from a randomized trial of conduits. Ann Thorac Surg, 2007, 84 (3):795-799.
11.  Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg, 2004, 77 (1):93-101.
12.  Cameron A, Davis KB, Green G, et al. Coronary bypass surgery with internal-thoracic-artery grafts―effects on survival over a 15-year period. N Engl J Med, 1996, 334 (4):216-219.
13.  Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs conventional coronary artery bypass grafting:early and 1-year graft patency, cost, and quality-of-life outcomes:a randomized trial. JAMA, 2004, 291 (15):1841-1849.
14.  Kim KB, Cho KR, Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass:serial comparison using early, 1-year, and 5-year postoperative angiograms. J Thorac Cardiovasc Surg, 2008, 135 (2):300-307.
15.  Sawhney N, Moses JW, Leon MB. Treatment of left anterior descending coronary artery disease with sirolimus-eluting stents.
16.  Hannan EL, Wu C, Walford G, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl.
17.  Byrne JG, Leacche M, Vaughan DE, et al. Hybrid cardiovascular procedures. JACC Cardiovasc Interv, 2008, 1 (5):459-468.
18.  Shirani S, Boroumand MA, Abbasi SH, et al. Preoperative carotid artery screening in patients undergoing coronary artery bypass graft surgery. Arch Med Res, 2006, 37 (8):987-990.
19.  Lund C, Hol PK, Lundblad R, et al. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg, 2003, 76 (3):765-770.
  1. 1. Circulation, 2004, 13 (11):54-55.
  2. 2. J Med, 2008, 358 (4):331-341.
  3. 3.  Angelini GD, Wilde P, Salerno TA, et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet,1996, 347 (9003):757-758.
  4. 4.  Amodeo VJ, Donias HW, Dancona G, et al. The hybrid approach to coronary artery revascularization:minimally invasive direct coronary artery bypass with percutaneous coronary intervention. Angiology, 2002, 53 (6):665-669.
  5. 5.  Wittwer T, Cremer J, Boonstra P, et al. Myocardial“hybrid” revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty:preliminary results of a multicentre study. Heart, 2000, 83 (1):58-63.
  6. 6.  Bonaros N, Schachner T, Wiedemann D, et al. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and techniques from a two-center experience. Eur J Cardiothorac Surg, 2011, 40 (4):783-787.
  7. 7.  Bravata DM,Gienger AL, Mcdonald KM, et al. Systematic review:the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med, 2007, 147 (10):703-716.
  8. 8.  BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol, 2007, 49 (15):1600-1606.
  9. 9.  Kim KB, Cho KR, Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass:serial comparison using early, 1-year, and 5-year postoperative angiograms. J Thorac Cardiovasc Surg, 2008, 135 (2):300-307.
  10. 10.  Hayward PA, Buxton BF. Contemporary coronary graft patency:5-year observational data from a randomized trial of conduits. Ann Thorac Surg, 2007, 84 (3):795-799.
  11. 11.  Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg, 2004, 77 (1):93-101.
  12. 12.  Cameron A, Davis KB, Green G, et al. Coronary bypass surgery with internal-thoracic-artery grafts―effects on survival over a 15-year period. N Engl J Med, 1996, 334 (4):216-219.
  13. 13.  Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs conventional coronary artery bypass grafting:early and 1-year graft patency, cost, and quality-of-life outcomes:a randomized trial. JAMA, 2004, 291 (15):1841-1849.
  14. 14.  Kim KB, Cho KR, Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass:serial comparison using early, 1-year, and 5-year postoperative angiograms. J Thorac Cardiovasc Surg, 2008, 135 (2):300-307.
  15. 15.  Sawhney N, Moses JW, Leon MB. Treatment of left anterior descending coronary artery disease with sirolimus-eluting stents.
  16. 16.  Hannan EL, Wu C, Walford G, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl.
  17. 17.  Byrne JG, Leacche M, Vaughan DE, et al. Hybrid cardiovascular procedures. JACC Cardiovasc Interv, 2008, 1 (5):459-468.
  18. 18.  Shirani S, Boroumand MA, Abbasi SH, et al. Preoperative carotid artery screening in patients undergoing coronary artery bypass graft surgery. Arch Med Res, 2006, 37 (8):987-990.
  19. 19.  Lund C, Hol PK, Lundblad R, et al. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg, 2003, 76 (3):765-770.