SURGICAL-TREATMENT OF VARIANT ANGINA - USE OF PLEXECTOMY WITH AORTOCORONARY BYPASS
SURGICAL-TREATMENT OF VARIANT ANGINA - USE OF PLEXECTOMY WITH AORTOCORONARY BYPASS
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DOI：
10.1161/01.cir.61.5.877
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发表时间：
1980-01-01
期刊：
影响因子：
37.8
通讯作者：
SOOTS, G
中科院分区：
文献类型：
--
作者：
BERTRAND, ME;LABLANCHE, JM;SOOTS, G
主动脉冠状动脉搭桥术在冠心病患者的治疗中被广泛接受，但在变异性心绞痛的治疗中存在争议。已经描述了持续发作、移植物闭塞或术后梗死，并且可以通过在变异性心绞痛中经常观察到的持续痉挛来解释，这种持续痉挛可能闭塞移植血管的远端部分。在冠状动脉移植手术中可能增加丛神经切除术以防止痉挛。将35例变异型心绞痛手术患者分为两组。第1组（n = 13）仅行冠状动脉旁路移植术;第2组（n = 13）在心肌血运重建术的基础上行心肌丛切除术。平均随访时间为37个月。第1组和第20个月。第二组。通过临床研究、压力试验、移植物通畅性控制和麦角生物碱（甲基麦角碱）激发试验对结果进行评估。尽管在这些症状自发变异性很大的患者中难以评价各种治疗的效果，但在变异性心绞痛中，完全神经丛切除术联合冠状动脉搭桥术的结果（86%）优于单纯搭桥术（61%）。当神经丛切除术联合搭桥术时，发作的复发率（5%）低于单独搭桥术（18%）。
Aortocoronary bypass surgery, widely accepted in the treatment of patients with coronary artery disease, is controversial in the management of variant angina. Persistence of attacks, occluson of the graft or postoperative infarction have been described and could be explained by a persistent spasm frequently observed in variant angina that might occlude the distal part of the grafted vessel. Plexectomy might be added to the aortocoronary graft procedure to prevent the spasm. Patients (35) with variant angina who had surgery were divided into 2 groups. Group 1 (n = 13) had aortocoronary bypass alone; the patients in group 2 had plexectomy in addition to the myocardial revascularization. The average follow-up period was 37 mo. in group 1 and 20 mo. in group 2. The results were assessed by clinical study, stress testing, control of patency of the grafts and provocative test with an ergot alkaloid (methergine). Despite the difficulties of evaluating the effects of the various treatments in these patients with a wide spontaneous variability of symptoms, a complete plexectomy associated with aortocoronary bypass gives better results (86%) than bypass alone (61%) in variant angina. The recurrence rate of attacks was lower (5%) when plexectomy was associated with bypass than with bypass alone (18%).