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首页> 外文期刊>Journal of Thoracic Disease >Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation
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Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation

机译：分期经皮冠状动脉介入治疗，然后微创二尖瓣手术与联合冠状动脉搭桥术和二尖瓣手术相结合，可治疗两支冠状动脉疾病和中度至重度缺血性二尖瓣反流

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Background: The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. Methods: All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. Results: There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0–2] versus 3 units (IQR, 1–4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. Conclusions: PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.
机译：背景：对于伴发两支冠状动脉疾病（CAD）和中重度缺血性二尖瓣关闭不全（IMR）的最佳治疗方法尚不清楚。我们比较了该人群中分期经皮冠状动脉介入治疗后微创二尖瓣手术（PCI + MIVS）与冠状动脉搭桥术和二尖瓣手术联合（CABG + MVS）的结果。方法：回顾性分析2009年2月至2014年4月在我院接受PCI + MIVS或CABG + MVS治疗的所有两支血管CAD和中重度IMR患者。结果：确定的9例行PCI + MIVS的患者和15例行CABG + MVS的患者，平均年龄分别为71±7岁和70±7岁（P = 0.86）。除术前使用氯吡格雷的患病率较高（78％vs 27％，P = 0.03）和左前降支加左旋支CAD（78％vs 27％，P）外，其余两组的基线特征相似。 = 0.03），接受PCI + MIVS的患者。 PCI + MIVS方法与平均心肺旁路减少（111±41 vs 167±49 min，P = 0.01）和主动脉夹钳（79±32 vs 129±35 min，P = 0.003）次数相关，且中位数较少与CABG + MVS相比，术中密集输血的次数{2 [四分位间距（IQR），0-2]相对于3个单位（IQR，1-4），P = 0.05}。二尖瓣修复率，术后并发症，30天死亡率和1年生存率在两种手术方法之间没有差异。结论：与CABG + MVS相比，PCI + MIVS用于两支血管CAD和中至重度IMR是可行的，并且具有令人满意的结果。

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