Surgical treatment for left main coronary artery stenosis in patients of advanced age / 中华老年医学杂志

ABSTRACT

Objective To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD).Methods From 2005 to 2014,101 elderly patients (≥ 80 years)with LMCAD underwent off-pump CABG in our hospital.Among them,82 were male and 19 were female,with an average age of(81.4 ± 1.7)years.Seventy-six cases(75.2 ％) had significant left main stenosis (≥ 70 ％) and twenty-five cases had left main stenosis less than 70％.The average left ventricular end diastolic diameter was(48.2 ± 8.3) cm;left ventricular ejection fraction was more than 50％ in 89 cases and 30％ to 50/％ in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition,56 patients had New York Heart Association functional classification Ⅰ to Ⅱ,and 45 patients had classification]] to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰ to Ⅲll,two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG.Results The average operation time was(3.9 ± 0.8) h,the average number of bridging vessels were (3,0 ± 1.0) roots,ICU monitoring time was(50.2 ± 46.0) h,and ventilator assisted breathing time was (42.9 ± 68.5) h.Six patients (5.9 ％) had secondary thoracotomy hemostasis,five(4.9 ％) had secondary tracheal intubation,and four(4.0 ％)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases (2.9 ％) during operation and in 11 cases(10.9 ％) after operation.Two cases (2.0 ％) had perioperative myocardial infarction and 8 cases (7.9％) died after operation during hospitalization.The median follow-up time was 6(1-11)years,and 17(16.8％)had all-cause mortality.Conclusions Although the two independent high-risk factors,old age and left main stenosis often coexist,off-pump CABG and perioperative management are still safe and effective treatments.