冠心病外科治療英文INTRODUCTION

CoronaryArteryDisease（CAD)isoneofthemostcommonandseriouseffectsofaging.Fattydepositsbuildupinbloodvesselwallsandnarrowthepassagewayforthemovementofblood.Theresultingcondition,calledatherosclerosisoftenleadstoeventualblockageofthecoronaryarteriesanda“heartattack”.2021/4/272

2021/4/273Since1900,CADhasbeentheNo.1killerintheUnitedStateseveryyearbut1918.Nearly2,600AmericansdieofCADeachday,anaverageof1deathevery33seconds.CADclaimsmoreliveseachyearthanthenext5leadingcausesofdeathcombined,whicharecancer,chroniclowerrespiratorydiseases,accidents,diabetesmellitus,influenzaandpneumonia.Almost150,000AmericanskilledbyCADeachyearareunderage65.Betyoudidn'tknow....2021/4/274INCHINAFrom1984~1998,themortalityratehasrisen.CADhasbeentheNo.3killerinChina.In2003,theprevalencerateofCADis4.6‰In2004,themortalityrateofCADis

46.27/100thousand.

Thisrateislowerthantheratein2000Newtrend:thepatientsarebecomemoreandmoreyounger,from1984~1998,themortalityrateofyoungmankindhaslargelyrisen,theextentreachto154%

dataiscomefrom《TheChineseCardiovascularDiseasereport2005》2021/4/275

ThesecelebritiesarealldiedofCAD.mostofthemarenotveryold.Theredeathevokedpeople’smoreattentiontoCAD2021/4/276THERISKHypertensionSmokingAbnormityofbloodlipidObesityoroverweightAbnormityofbloodsugarUnhealthylifestyle2021/4/277RiskFactorsUncontrollableSexHereditaryRaceAgeControllableHighbloodpressureHighbloodlipidSmokingPhysicalactivityObesityDiabetesStressandanger2021/4/278SignsandSymptomsNone:Thisisreferredtoassilentischemia.BloodtoyourheartmayberestrictedduetoCAD,butyoudon’tfeelanyeffects.Chestpain:Ifyourcoronaryarteriescan’tsupplyenoughbloodtomeettheoxygendemandsofyourheart,theresultmaybechestpaincalledanginapectorisShortnessofbreath:SomepeoplemaynotbeawaretheyhaveCADuntiltheydevelopsymptomsofcongestiveheartfailure-extremefatiguewithexertion,shortnessofbreathandswellingintheirfeetandankles.Heartattack:Resultswhenanarterytoyourheartmusclebecomescompletelyblockedandthepartyofyourheartmusclesfedbythatarterydies.Signs&SymptomsNoneChestPainShortnessOfBreathHeartAttack2021/4/279Electrocardiogram：wecanseetheECGsignsofmyocardialischemiaorinjury.ThisisvaluableforourdiagnosesCoronaryAngiography:thisisaveryusefultest,theresultwouldbethekingstandardforthediagnoses.ItalsocandefinitudethepathologicalarteriesBloodtests:usedtoevaluatekidneyandthyroidfunctionaswellastocheckcholesterollevelsandthepresenceofanemia.ChestX-ray:showsthesizeofyourheartandwhetherthereisfluidbuilduparoundtheheartandlungs.Echocardiogram:showsagraphicoutlineoftheheart’smovementTestsInclude2021/4/2710Manypeopleareabletomanagecoronaryarterydiseasewithlifestylechangesandmedications.Otherpeoplewithseverecoronaryarterydiseasemayneedangioplasty(PCI)orsurgery(CABG).Treatment2021/4/2711Treatment(continued)1)Stenting

astentisintroducedintoabloodvesselonaballooncatheterandadvancedintotheblockedareaofthearterytheballoonistheninflatedandcausesthestenttoexpanduntilitfitstheinnerwallofthevessel,conformingtocontoursasneededtheballoonisthendeflatedanddrawnbackThestentstaysinplacepermanently,holdingthevesselopenandimprovingtheflowofblood.2021/4/2712surgicalTreatment(continued)Bypasssurgery

healthybloodvesselisremovedfromleg,armorchestbloodvesselisusedtocreatenewbloodflowpathinyourheartthe“bypassgraft”enablesbloodtoreachyourheartbyflowingaround(bypassing)theblockedportionofthediseasedartery.Theincreasedbloodflowreducesanginapectorisandtheriskofheartattack.2021/4/2713ConventionalCABG

（internationalrecognition）1onearterygraft(leftinternalmammaryarteryorleftsubclavianartery)2othersareveinGrafts(greatsaphenousvein)2021/4/2714ThebestgraftforCABG—ITAITA（internalthoracicartery）isthebestgraftandincommonuse.Datashows,10yearsafteroperation,90%patients’ITAgraftsarestillpatencyITAcanrisethelivability,decreasetheheartattackandre-operationSTSDatabaseshows,inAmerican,88%patientsuseoneITA;InEngland,therateis90%;Inourhospital(XiangYahospital),therateisalso90%.

oneITAmustbeused!2021/4/2715BITAORALLARTERIALGRAFTSomehospitalusingtwoITAs.DoseitbetterthansingleITA?(conclusion)

InAmerican,only3.5%patientsuseBITA.Wealsocanusemorethan2arterialgrafts.Theyare:ITA(oneortwo);RA(radialartery)andGE(rightgastroepiploicartery)

It'sbetterforyoungpatientstouseBITA!Thiswayisnotaroutine!2021/4/2716SITAvsBITALivability7years10years15years20yearsSITA87785837BITA89816750AnnThoracSurg2004；78：2005-142021/4/2717Operativemethods

On-pumpCABG70-80%Off-pumpCABG20-30%Difference：whiletheheartisarrestedandusecardiopulmonarybypassornotwhenoperating2021/4/2718

TheconclusionfromAHA(AmericanHeartAssociation)

Circulation，20051、on-pumpandoff-pump,whichisbetterisstillunconfirmed.Becausethemortalityrate,neuralfunctionandtheheartfunctionafteroperationisstillanalogical.2、Bothofthemhavegoodcurativeeffect,nomatteron-pumporoff-pumptheybothcanimprovetheprognosis.Butthepatients’prognosisismoredependonothernon-operativefactors.3、AlotofresearchindicatedthatthemortalityrateofCABGhasgreatdifference,from1%to6%.Thatmeanstheoperator’stechnique,theholisticmedicallevelandthepatients’ownconditionwillaffecttheprognosisalot.Off-pumpismorebetter?2021/4/2719Off-pumpONPUMPTechnicaldifficultyissmallDoctorscangraspthisoperativewayfastthegraftscanbepatencyforlongtimeafteroperationEasytooperatingonthecircumflexartery

Maybealotofgrafts

MaybeaLittlebleedingRenalinsufficiencymaybeseldom

Short-termneuralfunctioninjurymaybeseldomThenumberofdaysinhospitalmaybesmall

(Circulati