摘要
目的 总结急性Stanford A型主动脉夹层累及冠状动脉的外科治疗方法及结果.方法 回顾2010年3月至2013年8月177例急性Stanford A型主动脉夹层并行孙氏手术患者的临床资料,男130例,女47例;年龄（47.25±12.13）岁.29例累及冠状动脉并接受冠状动脉旁路移植手术.术前5例患者出现急性下壁心肌梗死,2例出现急性前壁或侧壁心肌梗死.手术均在患者送达医院24 h内进行.结果 右冠状动脉受累26例,左冠状动脉受累2例,1例患者双侧冠状动脉受累.22例冠状动脉受累的患者术前无心肌缺血的证据.急性Stanford A型主动脉夹层累及冠状动脉的患者与无冠状动脉受累的患者相比存在更高的院内病死率.结论 急性Stanford A型主动脉夹层一旦累及冠状动脉病死率较高,孙氏手术的同时行冠状动脉旁路移植手术对于挽救此类患者十分重要.
Objective Acute type A aortic dissection associated with coronary involvement is relatively rare,but it is a potentially fatal condition.Surgical treatment of these patients relied on coronary revascularization.However,coronary revascularization during aortic surgery poses a considerable surgical risk.Methods Between March 2010 and August 2013,we recruited 29 patients with coronary involvement caused by Acute type A aortic dissection who had undergone aortic surgery.All procedures were done on an emergency basis within 24 hours after the patient＇ s arrival.Results At admission,5 patients had acute inferior myocardial infarction and anterior or lateral in 2 before surgery.The right coronary artery was involved in 26 patients,the left in 2 patients,and both coronary arteries in 1 patient.22 patients with coronary involvement presented with no evidence of myocardial ischemia.Acute type A aortic dissection with coronary involvement is associated with higher in-hospital mortality rate.Conclusion In conclusion,coronary involvement due to acute type A aortic dissection does not always cause coronary malperfusion.Acute type A aortic dissection with coronary involvement is associated with high mortality rate.Aggressive coronary revascularization is essential to salvage these critically ill patients.
出处
《中华胸心血管外科杂志》
CSCD
2015年第5期282-285,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
