• 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)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(fù)合技術(shù)治療冠狀動(dòng)脈多支病變患者的早中期隨訪結(jié)果。方法  2007年 6月 至 2009年 12月共 104例冠狀動(dòng)脈多支病變患者在阜外心血管病醫(yī)院接受“一站式”復(fù)合技術(shù)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?cè)趦?nèi)的多支病變?!耙徽臼健睆?fù)合技術(shù)要點(diǎn)為:胸骨下段小切口左側(cè)第 2肋間橫斷胸骨,心臟不停跳完成左乳內(nèi)動(dòng)脈(left internal mammary artery,LIMA)至 LAD吻合,關(guān)胸后立即造影確定 LAD血運(yùn)重建滿意后即經(jīng)胃管給予波立維300 mg,靜脈肝素化[全血激活凝血時(shí)間( ACT)>250 s],行經(jīng)皮冠狀動(dòng)脈介入(percutaneous coronary intervention,PCI)治療其他非前降支狹窄病變。結(jié)果  本組患者均順利施行“一站式”復(fù)合技術(shù)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(shù)及院內(nèi)死亡。所有患者均獲得隨訪,平均隨訪 1.5年,其中 1例出現(xiàn)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(jié)論  “一站式”復(fù)合技術(shù)再血管化是治療多支冠狀動(dòng)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(fù)合技術(shù)治療冠狀動(dòng)脈多支病變患者早中期隨訪結(jié)果. 中國(guó)胸心血管外科臨床雜志, 2012, 19(3): 232-234. doi: 復(fù)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.