冠状动脉绕道患者的不可紧的上升性大动脉:增加频率的手术挑战
M Gaudino1, F Glieca, F Alessandrini
1Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscalinet.it
Circulation
|September 27, 2000
概括
在冠状动脉旁路移植 (CABG) 之前诊断不可缩的上升大动脉 (UAA) 是具有挑战性的. 虽然无触摸技术提供了更好的再血管化,但它们增加了外科手术期间的风险;无策略降低了风险,但可能导致复发性缺血.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 血管外科 血管外科
背景情况:
- 无法缩的上升大动脉 (UAA) 是一种在冠状动脉旁路移植 (CABG) 过程中越来越多地遇到的情况.
- 这项研究报告了UAA的CABG患者,重点是手术前诊断和手术管理.
研究的目的:
- 评估UAA手术前评估的诊断准确性.
- 为了比较UAA患者的CABG不同手术技术的结果.
主要方法:
- 对4812名连续CABG患者的回顾性分析.
- 术前诊断UAA基于胸部X射线图,心声图和冠状动脉血管图.
- 使用低温心室动 (无触摸技术) 或跳动的心脏再血管化 (无技术) 进行手术管理.
主要成果:
- 在4.3%的患者中诊断出UAA;在只有27.4%的患者中实现了手术前诊断.
- 预测UAA的因素包括70岁以上的年龄,糖尿病,吸烟,不稳定的心痛,扩散性冠状动脉病和外周血管病.
- 整体住院死亡率为2.8%,技术之间没有差异. 无触摸技术有较高的神经和脏并发症和更长的住院时间. 没有的技术有较高的中期缺血复发.
结论:
- 术前诊断UAA经常错过,需要修订诊断协议.
- 无触摸技术与更高的外科手术风险相关,但更好地恢复血管.
- 没有的策略提供了一个更顺的术后过程,但增加了缺血复发的风险.
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