冠心病左心功能低下患者冠狀动脉旁路移植术近远期结果分析课件

,冠心病左心功能低下患者冠状动脉旁路移植术近远期结果分析,2009年9月,宋云虎 中国医学科学院 阜外心血管病医院 北京协和医学院 阜外心血管病研究所,,研究背景,左 心 室 功 能 功 能 低 下,1、Hamad M, Erwin S,et al. Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction. Ann Thorac Surg 2008;85:488 93. 2、Faulkner SL, Stoney Ws, et al. Ishemic cardiomyopathy: medcial versus surgical treatment. J Thorac Cardiovasc Surg 1977;74:77.,药物治疗（5年死亡率可达68%）,CABG手术治疗,围术期研究较多， 死亡率在5%左右,长期随访研究较少,,研究目的,分析冠心病LVEF40%患者CABG手术近远期结果 分析影响手术及远期结果的相关危险因素,,6665例,研究对象,左心室功能不全的患者 （LVEF40%）共396例， 占5.94%,阜外心血管病医院1999年-2006年行CABG的患者,手术及远期生存率 相关危险因素分析,,LVEF40%的患者 围术期危险因素分析,LVEF40%的患者共396例 平均年龄598岁 男性354例，女性42例 297例患者在体外循环下手术（75） 围术期死亡17例（死亡率4.3%）,女，42，11%,,LVEF40%的患者 围术期危险因素分析,,LVEF40%的患者 围术期危险因素分析,患者术前情况,,LVEF40%的患者 围术期危险因素分析,患者手术情况,,LVEF40%的患者 围术期危险因素分析,围术期死亡组与存活组术前基本资料比较,,LVEF40%的患者 围术期危险因素分析,围术期死亡组与存活组术前基本资料比较,,LVEF40%的患者 围术期危险因素分析,手术相关资料,,结果显示：左主干病变、术前正性肌力药物是影响患者手术结果的术前因素。,结果： LVEF40%的患者 围术期危险因素分析,多因素logistic回归分析(1),,LVEF40%的患者 -远期随访结果分析,379例存活患者进行随访（97） 平均随访时间为5.11.9年（最长9年） 共49例患者远期死亡,女，42，11%,,LVEF40%的患者 -生存曲线,随访时间（年）,生存率,EF40%,,LVEF40%与LVEF 40% 远期生存率比较,EF40%,EF40%,随访时间（年）,生存率,p0.05,,LVEF40%的患者 -远期随访结果分析,COX-Regreesion回归分析结果,结果表明： 则年龄、术前正性肌力药等是术前独立危险因素。,,随访时间（年）,生存率,非低心排组,低心排组,结果：LVEF40%的患者 -术后低心排对远期生存率的影响,p0.05,,CPB与Off-Pump对远期生存率的应影响,P0.05,生存率,体外循环,非体外循环,,讨论,Ahmed W A., Tully P J., et al. Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction. Ann Thorac Surg 2009;87:1106 112. Isbir. S C, Yildirim T , Akgun S, et al. C oronary artery bypass surgery in patients with severe left ventricular dysfunction. International J of Cardio 2003,90:309316.,相关文献,,讨论,冠心病左心功能不全CABG手术近期疗效 独立危险因素 左主干病变 术前使用正性肌力药物 术前手术适应证 血管条件 存活心肌 室壁瘤 术中心肌保护和血流动力学稳定,,冠心病左心功能不全CABG手术远期疗效 独立危险因素 年龄 术前心功能状态 有效的血运重建（桥血管通畅） 完全再血管化,讨论,,结论,术前左心功能不全显著影响CABG近远期疗效 左主干病变、术前使用正性肌力药物是手术死亡危险因素 年龄和术前使用正性肌力药物是远期存活的危险因素 术前评估和围术期处理是提高近远期疗效的关键,,谢谢！,,英文版,,Outcome and risk factors for Coronary Artery Bypass Grafting in Patients With Coronary Heart Disease Left Ventricular Dysfunction,Sep, 2009,Yun-hu Song Department of Cardiovascular Surgery, Fu Wai Hospital, Beijing, China,,Background,Severe left ventricular dysfunction,Medicine only (survival rate after 5 years was 32%),CABG,Operative mortality was round 5%,long-term outcome In China?,1、Hamad M, Erwin S,et al. Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction. Ann Thorac Surg 2008;85:488 93. 2、Faulkner SL, Stoney Ws, et al. Ishemic cardiomyopathy: medcial versus surgical treatment. J Thorac Cardiovasc Surg 1977;74:77.,,AIMS,To analysis the operative and long-term outcomes of CABG for CAD with severe left ventricular dysfunction To analysis the risk factor for the operative and long-term outcomes,,Object,From January 1993 to December 2003, at Fu Wai hospital, underwent CABG.,6555 Cases Follow-up,left ventricular dysfunction （LVEF40%）396 cases， About 5.94%,The early and long-term survival of patients with left ventricular dysfunction,,LVEF40% patients perioperative analysis,LVEF40% patients:396 cases Mean age 62 8.7 years Male:354, female:42 Operation with CPB:297(75%) Postoperative deaths 17 patients(4.3%),女，42，11%,,LVEF 40% patients perioperative analysis,,Preoperative Characteristics,LVEF 40% patients perioperative analysis,,operative Characteristics,LVEF 40% patients perioperative analysis,,Preoperative Characteristics,LVEF 40% patients perioperative analysis,,Preoperative Characteristics,LVEF 40% patients perioperative analysis,,Operative Characteristics,LVEF 40% patients perioperative analysis,,CONCLUSION：Left main lesion and preoperative usage of intropic agent are risk factors for the operative reults,RESULTS,Multivariable Logistic Regression (1),,LVEF40% patients -long-term outcome,379 patients followed up (97%) Mean follow-up period: 5.11.9 years Died:49 cases,女，42，11%,,Follow up（year）,Survival rate,EF40%,RESULTS： LVEF 40% patients -long-term outcome,,Compare: LVEF40% and LVEF 40%,EF40%,EF40%,p0.05,Survival rate,Follow up（year）,,LVEF40% patients -long-term outcome,COX-Regreesion,CONCLUSION： Age and preoperative usage of intronic agent are risk factors for the long term survival.,,Normal co,Low co,p0.05,Survival rate,Follow up（year）,RESULTS： LVEF40% patients - The impact of post-operative CO on long-term survival,,RESULTS：LVEF40% patients CPB and Off-Pump on long-term survival,P0.05,Survival rate,On Pump,Off-pump,,Discussion,Ahmed W A., Tully P J., et al. Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction. Ann Thorac Surg 2009;87:1106 112. Isbir. S C, Yildirim T , Akgun S, et al. C oronary artery bypass surgery in patients with severe left ventricular dysfunction. International J of Cardio 2003,90:309316.,Results from literatures,,Discussion,To improve the early results of CABG for CAD with low LVEF Independent risk factors LM lesion Preoperative usage of inotropic agent Indication for operation Coronary artery fit for grafting Survived myocardium Ventricular aneurysm Per