Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

孙忠东 ¹ , 池一凡 ² , 矫艳 ¹ , 孙龙 ² , 生伟 ² ,  任冠桦 ¹

1. ;
2. ;

Corresponding author：

任冠桦, Email: 任冠桦，Email: szd118@sina.com

Keywords：

冠状动脉旁路移植术; 冠状动脉粥样硬化性心脏病; 术后处理; 老年; 心肌缺血; 并发症

DOI：

10.7507/1007-4848.20160094

Video：

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目的分析75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的治疗效果和临床经验。方法回顾性分析山东省潍坊市人民医院和青岛市市立医院自2005年1月至2014年1月109例75岁以上行CABG术患者的临床资料。其中，男63例、女46例，平均年龄（78.1±4.2）岁，均为多支血管病变。术前心功能分级（NYHA） Ⅳ级23例、Ⅲ级57例、Ⅱ级29例。术中行非体外循环CABG （OPCABG） 92例，体外循环下行CABG （on pump CABG）术9例，体外循环辅助心脏不停跳下CABG （on pump beating heart CABG）术8例。结果平均移植血管（2.5±1.4）支，围术期死亡4例，死亡率3.7%。其中，低心排血量综合征死亡1例，心律失常心室颤动死亡1例，肾衰和胃肠道并发症导致多器官衰竭死亡2例。术后主要并发症为心律失常、低心排血量综合征和肺部感染。105例生存患者95例获得随访，随访6～90 （45±26）个月，随访率90.5%。随访期间心源性死亡1例，非心源性死亡4例。患者心功能分级（NYHA）Ⅰ级81例，Ⅱ级18例，Ⅲ级2例，心绞痛消失。结论 75岁以上冠心病患者行冠状动脉旁路移植术可改善患者症状，缓解心绞痛，提高生活质量，具有良好的近中期效果。

Citation： 孙忠东, 池一凡, 矫艳, 孙龙, 生伟, 任冠桦. Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 405-407. doi: 10.7507/1007-4848.20160094 Copy

1.	Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and over all hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation, 1995, 91(3): 677-684.
2.	Yanagawa B, Algarni KD, Yau TM, et al. Improving results for nary artery bypass graft surgery in the elderly. Eur J Cardioac Surg, 2012, 42(3): 507-512.
3.	Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
4.	Reents W, Hilker M, Brgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-15.
5.	Harskamp RE, Puskas JD, Tijssen JG, et al. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ≥65 years with multivessel coronary artery disease. Am J Cardiol, 2014, 114(2): 224-229.
6.	Jongman RM, Zijlstra JG, Kok WF, et al. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses: A prospective randomized study. Shock, 2014, 42(2): 121-128.
7.	Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
8.	池一凡, 孙忠东, 侯文明, 等. 急性心肌梗死外科治疗临床效果和手术时机的探讨. 中国胸心血管外科临床杂志, 2011, 18(6): 531-535.
9.	池一凡, 牛兆倬, 侯文明, 等. 急性心肌梗死合并心源性休克手术治疗六例. 中国胸心血管外科临床杂志, 2011, 18(1): 77-79.
10.	谢波, 薛松, 连锋, 等. 急性心肌梗死近期行非体外循环冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2012, 19(5): 511-515.
11.	Bak E, Marcisz C. Quality of life in elderly patients following coronary artery bypass grafting. Patient Prefer Adherence, 2014, 14(8): 289-299.

1. Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and over all hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation, 1995, 91(3): 677-684.
2. Yanagawa B, Algarni KD, Yau TM, et al. Improving results for nary artery bypass graft surgery in the elderly. Eur J Cardioac Surg, 2012, 42(3): 507-512.
3. Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
4. Reents W, Hilker M, Brgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-15.
5. Harskamp RE, Puskas JD, Tijssen JG, et al. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ≥65 years with multivessel coronary artery disease. Am J Cardiol, 2014, 114(2): 224-229.
6. Jongman RM, Zijlstra JG, Kok WF, et al. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses: A prospective randomized study. Shock, 2014, 42(2): 121-128.
7. Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
8. 池一凡, 孙忠东, 侯文明, 等. 急性心肌梗死外科治疗临床效果和手术时机的探讨. 中国胸心血管外科临床杂志, 2011, 18(6): 531-535.
9. 池一凡, 牛兆倬, 侯文明, 等. 急性心肌梗死合并心源性休克手术治疗六例. 中国胸心血管外科临床杂志, 2011, 18(1): 77-79.
10. 谢波, 薛松, 连锋, 等. 急性心肌梗死近期行非体外循环冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2012, 19(5): 511-515.
11. Bak E, Marcisz C. Quality of life in elderly patients following coronary artery bypass grafting. Patient Prefer Adherence, 2014, 14(8): 289-299.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years

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