目的介绍心脏瓣膜手术同期行冠状动脉旁路移植术的治疗体会。方法 2003年5月至2013年12月,心脏瓣膜手术同期行冠状动脉旁路移植术29例,患者男性13例,女性16例。年龄35~70岁。共搭桥54根。二尖瓣成形术8例;主动脉瓣机械瓣置换术3例;二尖瓣机械瓣置换术10例;主动脉瓣置换及二尖瓣成形术4例;双瓣膜置换术4例。结果术后早期死亡5例,病死率17.24%,其中左室破裂2例,多器官功能衰竭2例,室颤1例。随访3~24个月,心功能改善,无严重心绞痛发作。结论风湿性瓣膜病患者,有冠心病高危因素者,应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全者如瓣膜成形效果差时,应选择保留瓣下结构的瓣膜置换术。
Objective?To?introduce?the?outcome??of??combined??valve??replacement??and???coronary??artery??bypass??grafting??in??patient??with??valvular?heart??disease??associated??coronary??heart??disease.?Methods?May?2003?to?December?2013,?heart?valve?surgery?over?the?same?period?coronary?artery?bypass?grafting?29?cases;?male?13?cases,?female?16?cases.?Age?35?to?70?years?old.?Total?bypass?54?root.?Results?5?cases?death?with?early?postoperative,?the?death?rate?was?17.24%,?Followed?up?for?3-16?months,?Patients?recovered?and?was?discharged?with??improved??heart??function.?Conclusion?Coronary?angiography?should be carried out routinely in patients with valvular heart disease, especially with coronary heart disease risk factors. Ischemic mitral insufifciency should choose?to?retain?disc?directly?under?the?structure?of?valve?replacement,?prevent?the?increased?mortality?and?postoperative?complications.