2020 年第 9 期 第 15 卷

冠状动脉粥样硬化性心脏病合并中度缺血性二尖瓣反流接受单纯冠状动脉旁路移植术患者的临床特征分析

Analysis of clinical characteristics of patients with coronary atherosclerotic heart disease and moderate ischemic mitral regurgitation

作者：吴立松董然付威马小龙

英文作者：Wu Lisong Dong Ran Fu Wei Ma Xiaolong 

单位：首都医科大学附属北京安贞医院心外科100029 

英文单位：Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠状动脉粥样硬化性心脏病；中度缺血性二尖瓣反流；冠状动脉旁路移植术

英文关键词：Coronaryatheroscleroticheartdisease;Moderateischemicmitralregurgitation;Coronaryarterybypassgrafting

• 摘要：

• 目的 分析冠状动脉粥样硬化性心脏病（冠心病）合并中度缺血性二尖瓣反流（IMR）并接受单纯冠状动脉旁路移植术（CABG）患者的临床资料和远期随访疗效。方法 选取2009年1月至2018年12月在首都医科大学附属北京安贞医院诊断为冠心病合并中度IMR患者750例，均行单纯CABG治疗，收集患者的基线资料、手术相关资料、围术期并发症及术后相关资料、随访资料,比较患者术前、术后出院时及随访时的超声心动图指标水平，包括左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、二尖瓣反流面积。结果 750例患者中男性521例（69.5%），平均年龄（63±9）岁，冠状动脉造影单支病变22例（2.9%）、两支病变153例（20.4%）、三支病变575例（76.7%）。726例（96.8%）患者接受了非体外循环CABG术，平均手术时间为（4.2±1.2）h，497例（66.3%）患者桥血管吻合采用序贯吻合。术后院内死亡39例（5.2%），心力衰竭12例（1.6%）、心肌梗死37例（4.9%）、脑血管事件4例（0.5%），术后出院前超声心动图二尖瓣无反流197例（26.3%）、少量反流466例（62.1%）、中量反流87例（11.6%），二尖瓣反流面积小于术前［(2.2±0.9)cm2比（5.7±1.3）cm2］（t=7.882，P＜0.001）。术后1年有717例（95.6%）患者得到随访，平均随访时间为（5.6±1.8）年，患者2、4、6、8年生存率分别为93.6%、88.1%、80.2%、77.3%。术后出院前和术后1年随访患者左心室射血分数均高于术前，左心室舒张末期内径、左心室收缩末期内径均短于术前（均P＜0.05）。随访发生全因性死亡事件105例（14.6%）、心源性死亡44例（6.1%）、心肌梗死28例（3.9%）、心力衰竭64例（8.9%），14例（2.0%）患者接受了经皮冠状动脉介入再血管化治疗，术后1年纽约心脏病协会心功能分级Ⅰ级66例（9.2%）、Ⅱ级562例（78.4%）、Ⅲ级65例（9.1%）、Ⅳ级24例（3.3%）。结论 对于冠心病合并中度IMR的患者，单纯CABG治疗远期疗效较好。

• Objective To explore clinical characteristics of patients with coronary atherosclerotic heart disease (CAD) and moderate ischemic mitral regurgitation (IMR) who received isolated coronary artery bypass grafting (CABG). Methods From January 2009 to December 2018, 750 patients who were diagnosed of CAD with moderate IMR and underwent isolated CABG in Beijing Anzhen Hospital, Capital Medical University were included. The baseline data, operation related data, perioperative complications, postoperative related data and follow-up data were collected. The echocardiographic results were compared, including left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and mitral regurgitation area. Results There were 521 male patients (69.5%) ; the average age was (63±9)years; 22 patients (2.9%) had single vessel lesions; 153 patients (20.4%) had two vessels lesions; 575 patients (76.7%) had three vessels lesions. Seven hundred and twenty-six patients (96.8%) underwent off-pump CABG; the average operation time was (4.2±1.2)h and 497 patients (66.3%) underwent sequential anastomosis. There were 39 patients (5.2%) died after operation in the hospital; 12 patients (1.6%) had heart failure; 37 patients (4.9%) had myocardial infarction and 4 patients (0.5%) had cerebrovascular events. There were 197 patients (26.3%) without mitral regurgitation, 466 patients (62.1%) with mild mitral regurgitation and 87 patients (11.6%) with moderate mitral regurgitation. The area of mitral regurgitation after operation was smaller than that before operation ［(2.2±0.9)cm2 vs (5.7 ± 1.3)cm2］ (t=7.882, P<0.001). One year after operation, 717 patients (95.6%) were followed up with an average follow-up time of （5.6±1.8）years. The 2, 4, 6, and 8-year survival rates were 93.6%(671/717), 88.1%(632/717), 80.2%(575/717) and 77.3%(554/717), respectively. LVEF before discharge and during follow-up were higher than that before operation; LVEDD and LVESD were shorter than those before operation (all P<0.05). During follow-up， all-cause death occurred in 105 patients (14.6%); cardiac death was in 44 patients (6.1%); myocardial infarction was in 28 patients (3.9%); heart failure was in 64 patients (8.9%); percutaneous coronary intervention and revascularization was in 14 patients (2.0%). There were 66 patients (9.2%), 562 patients (78.4%), 65 patients (9.1%) and 24 patients (3.3%) classified as grade Ⅰ, grade Ⅱ, grade Ⅲ and grade Ⅳ by the New York Heart Association at 1 year after operation. Conclusion For patients with CAD and moderate IMR, isolated CABG can improve long-term oucomes.