Trends in selection and results of coronary artery reoperations.
Trends in selection and results of coronary artery reoperations.
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冠状动脉再手术的选择和结果的趋势。
DOI：
10.1016/s0003-4975(10)60474-2
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
P. C. Taylor
中科院分区：
文献类型：
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作者：
Floyd D. Loop;B. Lytle;Carl C. Gill;L. R. Golding;Delos M. Cosgrove;P. C. Taylor
前1,000例接受孤立性冠状动脉再手术的患者被分为4个队列，每组250例：1969年至1976年; 1976年至1979年; 1979年至1981年; 1981年至1982年。移植物失败作为再次手术的指征从第1组的26%上升到第4组的40%，间隔从17个月延长到61个月，可能是术后5 - 10年延迟闭合的结果。先前未移植血管中的进展性动脉粥样硬化从第1组的62%降至第4组的23%，这一下降归因于最初更完全的血运重建。三支血管病变、左冠状动脉主干狭窄和左心室损害的频率在再次手术的候选者中继续上升。然而，手术死亡率已从5%下降到2%，大多数其他形式的围手术期发病率显着下降时，早期与后来的经验相比。每例患者的移植物数量从1.4增加到2.3，再次手术中的完全血运重建从65%增加到76%。平均29个月后，154例患者在再次手术后再研究的移植物通畅率为81%。移植物的通畅性与先前涉及移植物失效的动脉和先前未移植的动脉相似。前三个队列中患者的5年精算生存率（平均57个月）为89%。再次手术前的疾病程度和左心室功能以及血运重建的完整性显著影响生存率;再次手术的原因（即移植物闭合、进行性动脉粥样硬化或两者）不影响生存率。
The first 1,000 patients undergoing isolated coronary artery reoperation were divided into four cohorts of 250 patients each: 1969 to 1976; 1976 to 1979; 1979 to 1981; and 1981 into 1982. Graft failure as an indication for reoperation rose from 26% in Group 1 to 40% in Group 4, and the interval lengthened from 17 to 61 months, presumably a result of late closures 5 to 10 years postoperatively. Progressive atherosclerosis in previously ungrafted vessels has decreased from 62% in Group 1 to 23% in Group 4, a decline attributed to more complete revascularization initially. The frequency of three-vessel disease, stenosis of the left main coronary artery, and left ventricular impairment continues to rise in candidates for reoperation. Yet, operative mortality has declined from 5% to 2%, and most other forms of perioperative morbidity have decreased significantly when the early years are compared with the later experience. The number of grafts per patient has increased from 1.4 to 2.3, and complete revascularization in reoperations has increased from 65% to 76%. After a mean of 29 months, graft patency was 81% overall in 154 patients restudied after reoperation. Patency was similar for grafts to arteries previously involved with graft failure and to arteries not previously grafted. Five-year actuarial survival for patients in the first three cohorts (mean, 57 months) was 89%. Survival was affected significantly by extent of disease and left ventricular performance before reoperation and by completeness of revascularization; survival was not affected by the reason for reoperation, that is, graft closure, progressive atherosclerosis, or both.