Calafiore A M, Teodori G, Di Giammarco G, Vitolla G, Maddestra N, Paloscia L, Zimarino M, Mazzei V
Division of Cardiac Surgery, University G. D Annunzio, Chieti, Italy.
Ann Thorac Surg. 1999 Feb;67(2):450-6. doi: 10.1016/s0003-4975(98)01194-1.
Lack of angiographic results and technical difficulty in grafting the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We describe our experience to demonstrate the feasibility of coronary surgical intervention without CPB in multivessel disease.
From May 21, 1997, through February 1998, 227 patients underwent revascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B). Group A included a greater number of high-risk patients.
Mean +/- SD anastomoses per patient were 2.5 +/- 0.6 in group A and 2.8 +/- 0.8 in group B (p = NS). No patient died in group A, whereas 1 patient (0.9%) died in group B. The postoperative complication rate was low in both groups, but intensive care unit and in-hospital stays were shorter in group A than in group B (14.1 +/- 7.1 versus 27.3 +/- 36 hours, p < 0.001, and 4.1 +/- 1.6 versus 5.4 +/- 2.4 days, p < 0.001, respectively [group A versus group B]). Sixty-seven patients in Group A (54.9%) underwent postoperative angiography 33 +/- 35 days after operation. The patency rate was 98.9% (98.2% for the marginal branches).
Arterial revascularization of the coronary arteries without CPB is feasible, with results similar to those obtained with CPB. The two techniques, in our opinion, are complementary, not antagonistic.
缺乏血管造影结果以及在侧壁和后壁血管移植中的技术难度降低了人们对非体外循环（CPB）心肌血运重建的兴趣。我们描述我们的经验以证明在多支血管病变中进行非体外循环冠状动脉手术干预的可行性。
从1997年5月21日至1998年2月，227例患者首次接受了使用两根或更多动脉移植物的血运重建手术：122例非体外循环（A组）和105例体外循环（B组）。A组中高危患者数量更多。
A组患者平均每位的吻合口数为2.5±0.6，B组为2.8±0.8（p=无显著差异）。A组无患者死亡，而B组有1例患者（0.9%）死亡。两组术后并发症发生率均较低，但A组的重症监护病房和住院时间均短于B组（分别为14.1±7.1对27.3±36小时，p<0.001，以及4.1±1.6对5.4±2.4天，p<0.001[A组对B组]）。A组67例患者（54.9%）在术后33±35天接受了血管造影。通畅率为98.9%（边缘支为98.2%）。
非体外循环下冠状动脉动脉血运重建是可行的，结果与体外循环相似。我们认为，这两种技术是互补的，而非对立的。
