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Ngày xuất bản:
02/11/2020
Ngày xuất bản Online:
02/11/2020
Số lượt xem tóm tắt: 426
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Dũng, V. H. ., Phan , N. V. ., & Phương, P. K. . (2020). Phẫu thuật bắc cầu động mạch vành cho người già trên 70 tuổi. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam, 20, 129-135. https://doi.org/10.47972/vjcts.v20i.98
Phẫu thuật bắc cầu động mạch vành cho người già trên 70 tuổi
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Tóm tắt
Nghiên cứu bao gồm 117 BN, nam giới : 85 (76%), tuổi trung bình 75,4 ± 2,6 năm Các bệnh nền kết hợp đi kèm gồm đái tháo đường 47 (40%), tăng huyết áp 95 (81%), rối loạn chuyển hóa mỡ 30 (25,6%), suy thận mạn 27(23%) bệnh lý mạch máu ngoại biên 10 (8,5%), bệnh phổi tắc nghẽn mãn 13 (11%).Bệnh mạch vành bao gồm hẹp thân chung >50% : 63 (53,8%); hẹp ba thân : 101 (86,3%); hẹp hai thân 7 (6%) và hẹp 1 thân : 9 (7,7%). Bệnh van tim kết hợp có 41 trường hợp (TH) bao gồm hở van hai lá 27, hẹp hở van hai lá 2 và hẹp van ĐMC 12 TH. Phẫu thuật cấp cứu và bán cấp cứu cho 16 BN (13,7%). Số cầu nối trung bình cho một BN là 2,95 ± 0,86. Tử vong phẫu thuật 3 (2,6%); mổ lại 11 BN (chảy máu 7 và viêm xương ức 4 TH). Các biến chứng khác như nhiễm trùng vết mổ 17, viêm phổi 17, nhiễm trùng huyết 4, rung nhĩ kịch phát sau mổ 20, suy thận cấp cần can thiệp 4, sảng, rối loạn nhận thức 8, nhũn não 2 TH. Thời gian nằm hồi sức trung bình : 4,6 ± 0,45 ngày (1-30 ngày) và thở máy trung bình 49,8 ± 8,8 giờ (2-288 giờ); thời gian nằm viện trung bình 17,2 ± 9,2 ngày (4-60 ngày). Thời gian theo dõi sau mổ trung bình : 47,6 ± 4,5 tháng ( 3-169 tháng ). Tử vong muộn 17 trường hợp ( 14,9%), do ung thư : 8 ; do suy tim : 3; đột tử : 2 ; không rõ nguyên nhân : 2 và do tai nạn 2 trường hợp.
Chi tiết bài viết
Từ khóa
CABG
Tài liệu tham khảo
1. Ascione R, Rees K, Santo K, Chamberlain MH, Marchetto G, Taylor F, Angelini GD. Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes. Eur.J Cardiothorac Surg 2002; 22(1):124-128.
2. Arun N, Samad S, Stephen C.Coronary artery bypass surgery in elderly people . Postgrad Med J 2007;83:154-158. doi: 10.1136/pgmj.2006.049742.
3. Benedetto U, Amrani M, and Raja SG. Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups. J Thorac Cardiovasc Surg 2014;148:2706-2711.
4. Cordeiro da Rocha AS, Pittella FJM, Rocha de Lorenzo A, Barzan V, Colafranceschi AS, Reis Brito JO, Antonio de Mattos M, Dutra da Silva PR. Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc 2012;27(1):45-51.
5. Dar MI, Hassan Dar A, Almani K, Mannan A, Khan AQ, Rizwani GH, Ahmad M . Coro-nary artery bypass surgery in old age group: Is age itself a barrier ? JPMA 2009 59:587.
6. Flather M, Rhee JW, Boothroyd DB, Boersma E, Brooks MM, Carrié D, et al. The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials. J Am Coll Cardiol 2012;60:2150-2157.
7. Habib RH, Dimitrova KR, Badour SA, Yammine MB, El-Hage-Sleiman AK, Hoffman DM, Geller CM, Schwann TA, Tranbaugh R. CABG Versus PCI: Greater Benefit in Long-Term Outcomes With Multiple Arterial Bypass Grafting. JACC 2015: 66 (13) :1417-1427.
8. Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, et al . Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with threevessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart Journal 2014 35, 2821-2830 doi:10.1093/eurheartj/ehu213.
9. Kitamura M, Endo M, Yamaki F, Ohtsuka G, Nishida H, and Koyanagi H. Long- Term Results of Coronary Artery Bypass Grafting in Elderly Japanese Patients.Ann Thorac Surg 1995;60:576-579.
10. Kramer A, Mastsa M, Paz Y, Locker C, Pevni D, Gurevitch J et al. Bilateral skeletonized internal thoracic artery grafting in 303 patients seventy years and older. J Thorac Cardiovasc Surg 2000;120:290-297.
11. Medalion B, Mohr R, Ben-Gal Y, Nesher N, Kramer A, Eliyahu S, and Pevni D.Arterial coronary artery bypass grafting is safe and effective in elderly patients . J Thorac Cardiovasc Surg 2015;150:607-612.
12. Mohr FW, Morice MC, Kappetein P, Feldman TE, Stahle E, Colombo A et al. CABG veus PCI in patients with 3-vesel disease and left main coronary disease: 5-year follow-up ò the randomised, clinical SYNTAX trial. Lancet 2013;381(I9867):629-638.
13. Muneretto C, Bisleri G, Negri A, Manfredi J, Carone E, Morgan JA, et al. Left internal thoracic artery radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: A prospective randomized evaluation. J Thorac Cardiovasc Surg 2004;127:179-184 .
14. Panesar SS, Athanasiou T, Nair S, Rao C, Jones C, Nicolaou M, Darzi A. Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass graftingcomparison between off-pump and onpump techniques. Heart 2006;92:1808-1816.
15. Pettinari M, Sergeant P, and Meuris B. Bilateral internal thoracic artery grafting increases long-term survival in elderly patients. Eur J Cardio-Thorac Surg 2014:1-7; doi:10.1093/ejcts /ezu206.
16. Posenau JT, Wojdyla DM, Shaw LK, Alexander KP, Ohman EM, Patel MR, Smith PK, Rao SV . Revascularization Strategies and Outcomes in Elderly Patients With Multivessel Coronary Disease. Ann Thorac Surg 2017; 104(1):107-115.
17. Ravi K.G, Prem S.S, Siobhan McG, Donna M.R, and Sary F.A. Nonelective cardiac surgery in the elderly: Is it justified? J Thorac Cardiovasc Surg 2010;140:103-109.
18. Ramanathan KB, Weiman DS, Sacks J, Morrison DA, Sedlis S, Sethi G, and Henderson WG. Percutaneous Intervention Versus Coronary Bypass Surgery for Patients Older Than 70 Years of Age With High-Risk Unstable Angina. Ann Thorac Surg 2005;80:1340-1346.
19. Rezende PC, Hueb W, Garzillo CL, Gomes Lima E, Hueb AC, Franchini Ramires JA, and RK Filho. Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: Effect of age in the Medicine, Angioplasty, or Surgery Study II trial. J Thorac Cardiovasc Surg 2013;146:1105-1112.
20. Saxena A, Đinh TD, Yap CH, Reid CM, Billah B, Smith JA, Shardey GC, and Newcomb AE. Critical Analysis of Early and Late Outcomes After Isolated Coronary Artery Bypass Surgery in Elderly Patients . Ann Thorac Surg 2011;92:1703-1711.
21. Sabzi F, Kazerani H, Jalali A, Samadi M, Ghasemi F. Coronary Arteries Bypass Grafting Surgery in Elderly Patients . J Teh Univ Heart Ctr 2013;8(2):76-88.
22. Safaie N, Montazerghaem H, Jodati A, Maghamipour N. In-Hospital Complications of Coronary Artery Bypass Graft Surgery in Patients Older Than 70 Years . J Cardiovasc Thorac Res, 2015, 7(2), 60-62.
23. Y. Luc JG, Graham MM, Norris CM, Shouli SA, Nijjar YS and Meye SR. Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study. BMC Cardiovascular Disorders 2017;17:275.
24. Yanagawa B, Algarni KD, M. Yau T, Rao V and Brister SJ. Improving results for coronary artery bypass graft surgery in the elderly. Euro J Cardio-Thorac Surg 2012 (42) 507–512.
2. Arun N, Samad S, Stephen C.Coronary artery bypass surgery in elderly people . Postgrad Med J 2007;83:154-158. doi: 10.1136/pgmj.2006.049742.
3. Benedetto U, Amrani M, and Raja SG. Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups. J Thorac Cardiovasc Surg 2014;148:2706-2711.
4. Cordeiro da Rocha AS, Pittella FJM, Rocha de Lorenzo A, Barzan V, Colafranceschi AS, Reis Brito JO, Antonio de Mattos M, Dutra da Silva PR. Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc 2012;27(1):45-51.
5. Dar MI, Hassan Dar A, Almani K, Mannan A, Khan AQ, Rizwani GH, Ahmad M . Coro-nary artery bypass surgery in old age group: Is age itself a barrier ? JPMA 2009 59:587.
6. Flather M, Rhee JW, Boothroyd DB, Boersma E, Brooks MM, Carrié D, et al. The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials. J Am Coll Cardiol 2012;60:2150-2157.
7. Habib RH, Dimitrova KR, Badour SA, Yammine MB, El-Hage-Sleiman AK, Hoffman DM, Geller CM, Schwann TA, Tranbaugh R. CABG Versus PCI: Greater Benefit in Long-Term Outcomes With Multiple Arterial Bypass Grafting. JACC 2015: 66 (13) :1417-1427.
8. Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, et al . Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with threevessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart Journal 2014 35, 2821-2830 doi:10.1093/eurheartj/ehu213.
9. Kitamura M, Endo M, Yamaki F, Ohtsuka G, Nishida H, and Koyanagi H. Long- Term Results of Coronary Artery Bypass Grafting in Elderly Japanese Patients.Ann Thorac Surg 1995;60:576-579.
10. Kramer A, Mastsa M, Paz Y, Locker C, Pevni D, Gurevitch J et al. Bilateral skeletonized internal thoracic artery grafting in 303 patients seventy years and older. J Thorac Cardiovasc Surg 2000;120:290-297.
11. Medalion B, Mohr R, Ben-Gal Y, Nesher N, Kramer A, Eliyahu S, and Pevni D.Arterial coronary artery bypass grafting is safe and effective in elderly patients . J Thorac Cardiovasc Surg 2015;150:607-612.
12. Mohr FW, Morice MC, Kappetein P, Feldman TE, Stahle E, Colombo A et al. CABG veus PCI in patients with 3-vesel disease and left main coronary disease: 5-year follow-up ò the randomised, clinical SYNTAX trial. Lancet 2013;381(I9867):629-638.
13. Muneretto C, Bisleri G, Negri A, Manfredi J, Carone E, Morgan JA, et al. Left internal thoracic artery radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: A prospective randomized evaluation. J Thorac Cardiovasc Surg 2004;127:179-184 .
14. Panesar SS, Athanasiou T, Nair S, Rao C, Jones C, Nicolaou M, Darzi A. Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass graftingcomparison between off-pump and onpump techniques. Heart 2006;92:1808-1816.
15. Pettinari M, Sergeant P, and Meuris B. Bilateral internal thoracic artery grafting increases long-term survival in elderly patients. Eur J Cardio-Thorac Surg 2014:1-7; doi:10.1093/ejcts /ezu206.
16. Posenau JT, Wojdyla DM, Shaw LK, Alexander KP, Ohman EM, Patel MR, Smith PK, Rao SV . Revascularization Strategies and Outcomes in Elderly Patients With Multivessel Coronary Disease. Ann Thorac Surg 2017; 104(1):107-115.
17. Ravi K.G, Prem S.S, Siobhan McG, Donna M.R, and Sary F.A. Nonelective cardiac surgery in the elderly: Is it justified? J Thorac Cardiovasc Surg 2010;140:103-109.
18. Ramanathan KB, Weiman DS, Sacks J, Morrison DA, Sedlis S, Sethi G, and Henderson WG. Percutaneous Intervention Versus Coronary Bypass Surgery for Patients Older Than 70 Years of Age With High-Risk Unstable Angina. Ann Thorac Surg 2005;80:1340-1346.
19. Rezende PC, Hueb W, Garzillo CL, Gomes Lima E, Hueb AC, Franchini Ramires JA, and RK Filho. Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: Effect of age in the Medicine, Angioplasty, or Surgery Study II trial. J Thorac Cardiovasc Surg 2013;146:1105-1112.
20. Saxena A, Đinh TD, Yap CH, Reid CM, Billah B, Smith JA, Shardey GC, and Newcomb AE. Critical Analysis of Early and Late Outcomes After Isolated Coronary Artery Bypass Surgery in Elderly Patients . Ann Thorac Surg 2011;92:1703-1711.
21. Sabzi F, Kazerani H, Jalali A, Samadi M, Ghasemi F. Coronary Arteries Bypass Grafting Surgery in Elderly Patients . J Teh Univ Heart Ctr 2013;8(2):76-88.
22. Safaie N, Montazerghaem H, Jodati A, Maghamipour N. In-Hospital Complications of Coronary Artery Bypass Graft Surgery in Patients Older Than 70 Years . J Cardiovasc Thorac Res, 2015, 7(2), 60-62.
23. Y. Luc JG, Graham MM, Norris CM, Shouli SA, Nijjar YS and Meye SR. Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study. BMC Cardiovascular Disorders 2017;17:275.
24. Yanagawa B, Algarni KD, M. Yau T, Rao V and Brister SJ. Improving results for coronary artery bypass graft surgery in the elderly. Euro J Cardio-Thorac Surg 2012 (42) 507–512.