心脏：同一天血管造影手术是安全的

对很多病人来说，同一天进行冠状动脉造影和手术可能是安全、更加方便并且成本较低的治疗方案。

“我们研发了一种方案使得病人能安全接受冠脉造影的同一天接受所选择的手术。” Mayo诊所的心脏专家David Holmes Jr 博士说。 

过去，在同一天进行冠脉造影和手术最大的风险可能会导致肾脏衰竭，是一种心脏术后死亡的独立前兆因子，死亡率据报道高达44.4%到63.7%。血管造影中使用的染料与放射对比试剂诱导的肾病相关。这种染料可导致肾脏衰竭。

当肾脏功能恶化，血清肌酐水平会在24到72小时内增高，3到5天内会达到高峰并在之后的3到5天恢复正常，这也是血管造影和手术必须间隔一段时间的原因。Holmes解释道。

Mayo的研究人员评价了236例医学记录，主要是关于在同一天同时进行心脏导管和手术修复的案例。病人的平均年龄为65岁并且33%为女性。226个病例中，血管造影显示28.3%的病例具有足够严重的冠状动脉疾病并需接受旁路手术的指征。有一例病人在手术后的30天死亡，4例病人之后有暂时性肾脏衰竭。

为了在同一天中同时进行血管造影和手术并且消除肾脏衰竭的可能性，临床医生使用了其它对比试剂。最小程度减低了对比试剂的用量并严密观察肾脏疾病的发生危险。根据病人的肾脏功能使用不同的造影试剂。Holmes说，“除外，确定病人是否会在此治疗方案中获益，必须仔细评价病人情况并在造影师和外科大夫间建立起良好的合作关系。”

Heart: Same-Day Angiography and Surgery Is Safe

It may be safe, much more convenient and less costly for many patients to undergo coronary angiography and elective valve surgery on the same day.

“We have developed a protocol to allow patients to safely have coronary angiography on the same day as their elective surgery,” says David Holmes Jr., M.D., a cardiologist at Mayo Clinic and one of the authors of the new study. 

One of the primary concerns of performing coronary angiography the same day as surgery is the risk of acute kidney failure, an independent predictor of death after cardiac surgery; mortality rates have been reported as high as 44.4 percent to 63.7 percent, the researchers report. The dye used in angiography is associated with radiocontrast-induced nephropathy, which can cause kidney failure. 

When worsening kidney function occurs, serum creatinine levels begin to increase after 24 to 72 hours, peak within three to five days and return to normal within another three to five days, thus the reason for the delay between the angiography and surgery, Holmes explains. 

Mayo researchers evaluated the medical records of 226 consecutive patients who had undergone cardiac catheterisation on the day of elective valve repair or replacement. The average age of the patient was 65 years old and 33 percent were female. Of the 226, angiography showed that 28.3 percent had severe enough coronary artery disease to also require bypass surgery, in addition to valve surgery. One patient died within 30 days following surgery, and four of the patients had transient renal failure. 

To make it possible to do angiography and surgery on the same day and largely diminish the possibility of renal failure, the physicians used other contrast agents. They minimized the total amount of contrast and carefully screened patients at risk for kidney disease. Different agents are used based on the patient’s kidney function, Holmes says. “In addition, deciding which patients may benefit from this streamlined approach is dependent on careful patient assessment and collaboration between the cardiologist and cardiovascular surgeon,” he says.