摘要
目的依据主动脉夹层累及冠状动脉的阜外分型,研究在急性Stanford A型主动脉夹层外科治疗中针对冠状动脉的处理策略和临床疗效。方法回顾阜外医院2014年4月至2016年8月急性StanfordA型主动脉夹层累及冠状动脉50例患者的临床资料。术中冠状动脉处理策略依据冠状动脉受累的阜外分型制订,主要包括冠状动脉修复术(coronary artery repair,CAR)和冠状动脉旁路移植术(coronary artery bypass grafting,CABG),分析不同治疗策略及方法的围手术期及中期随访结果。结果50例患者中CAR38例,CABG12例,其中包括术中补救性旁路移植(即CAR转CABG)3例和预防性旁路移植(即CAR加CABG)2例,随访4~32个月,平均18.6个月。CABG组围手术期死亡1例,死亡原因为术后低心排血量综合征及多器官功能衰竭,其余患者围手术期和随访期间均无死亡及主要不良心血管事件发生。结论基于阜外分型的冠状动脉处理策略对于冠状动脉受累的Stanford A型主动脉夹层的外科治疗具有一定的临床指导意义。
Objective To study the surgical treatment strategy of acute type A aortic dissection involving coronary artery on the basis of Fuwai type and evaluate the clinical efficacy.Methods 50 patients with coronary involvement were retrospec- tively analyzed from April 2014 to August 2016.The treatment mothod was based on Fuwai type,mainly including coronary ar- tery repair(CAR)and coronary artery bypass grafting(CABG).The clinical effect of this surgical strategy in the perioperative and follow-up period was analysed.Results A total of 50 patients were included.Of which,38 patients were treated with CAR,12 patients CABG,including 3 remedial bypass and 2 prophylactic bypass.All patients were followed up from 4 to 32 months,with an average time of 18.6 months.In group CABG,1 patient died of multiple organ failure after surgery,and the other patients had no major adverse cardiovascular events and deaths during perioperative period and follow-up period.Conclu- sion This strategy for the treatment of involved coronary arteries based on the Fuwai type has some guiding significance on the surgical treatment of acute type A aortic dissection.
作者
刘雁翔
李岩
史艺
梁盛华
孙晓刚
Liu Yanxiang;Li Yan;Shi yi;Liang Shenghua;Sun Xiaogang(State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Centre for Cardiovacular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2018年第11期641-645,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
主动脉夹层
冠状动脉受累
阜外分型
Aortic dissection
Coronary artery involved
Fuwai type
