Search

45岁以下冠心病患者的外科治疗

目的 分析45岁以下(≤45岁)冠心病患者的临床特点和早期外科治疗效果，总结其手术治疗经验。方法 收集2003年10月至2007年5月北京安贞医院心外科治疗的≤45岁冠心病患者302例的临床资料，其中男278例，女24例；平均年龄42岁。均有心绞痛病史，17.6%合并心肌梗死,42.0%合并有高血压病,15.9%合并糖尿病。302例中行单纯冠状动脉旁路移植术(CABG)288例（95.4%），行CABG+室壁瘤切除术14例（4.6%）。293例（97.0%）接受择期手术，9例（3.0%）接受急诊手术；41例（13.6%）在体外循环下完成手术。 结果 共移植冠状动脉旁路血管831支，其中262例（86.8%）采用乳内动脉桥，56例（18.5%）进行全动脉化再血管。术后30 d内死亡2例，其中1例死于低心排血量综合征，另1例死于心室颤动。术后发生低心排血量综合征3例，切口感染1例，活动性出血4例；302例患者术后呼吸机辅助时间中位数为17 h，住ICU时间中位数为19 h，术后住院时间中位数为11 d。随访287例，随访时间19～62个月，心功能Ⅰ~Ⅱ级，心绞痛缓解率97.5%（280／287），7例术后因心绞痛复发住心内科支架置入治疗后好转；随访期间无死亡。 结论 本组青年冠心病患者外科治疗较安全，近期结果满意，远期结果有待进一步随访。

巨大主动脉弓降部动脉瘤一例

Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation

ObjectiveTo investigate the surgical methods and efficacy of myocardial infarction combined with ventricular septal perforation.MethodsThe clinical data of 60 patients with myocardial infarction combined with ventricular septal perforation admitted to the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from 2009 to 2018 were retrospectively analyzed. There were 39 males and 21 females, aged 63.3±8.3 years.ResultsAmong the 60 patients, 43 (71.7%) patients were perforated in the apex, 11 (18.3%) in the posterior septum and 6 (10.0%) in the anterior septum. There were 24 (40.0%) patients of single coronary artery disease. Fourteen (23.3%) patients received intra-aortic balloon counterpulsation before surgery. The waiting time from ventricular septal perforation to surgery was 48.3 (3-217) d. All patients underwent ventricular septal perforation repair, among whom 53 (88.3%) patients received ventricular aneurysm closure or resection, and 49 (81.7%) patients received coronary artery bypass graft with an average of 2 distal anastomoses during the same period. Perioperative complications in the hospital included 8 (13.3%) deaths, 8 (13.3%) heart failure, 5 (8.3%) ventricular fibrillation, 3 (5.0%) pericardial tamponade, and 11 (18.3%) secondary thoracotomy and 11 (18.3%) residual shunt. Except for 8 patients who died in the hospital, the other 52 cured and discharged patients were followed up. The median follow-up time was 4.9 years. The 2-year and 5-year survival rate of the patients was 95.8%, and the 8-year survival rate was 89.0%. Major adverse cardiovascular events incidence was 19.2%, including 3 (5.8%) deaths, 5 (9.6%) heart failure, 2 (3.8%) myocardial infarction, and 4 (7.7%) cerebrovascular events.ConclusionFor patients with ventricular septal perforation after myocardial infarction, surgery is an effective treatment method. Although the perioperative mortality rate is high, satisfactory long-term results can be achieved by carefully choosing the operation timing and methods.

Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction

Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group. Results There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85% (21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure. Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.