Soltoski P, Salerno T, Levinsky L, Schmid S, Hasnain S, Diesfeld T, Huang C, Akhter M, Alnoweiser O, Bergsland J
The Center of Less Invasive Cardiac Surgery, Department of Cardiothoracic Surgery, CGF and The State University of New York at Buffalo, New York, USA.
J Card Surg. 1998 Sep-Oct;13(5):328-34. doi: 10.1111/j.1540-8191.1998.tb01093.x.
The surgical outcome of patients requiring conversion to cardiopulmonary bypass (CPB) during myocardial revascularization using the less invasive surgical approach (LISA) was assessed. The LISA was recently introduced as a technique for complete myocardial revascularization without CPB. It combines avoidance of CPB with the versatility of a median sternotomy for access to all coronary vessels. We have previously demonstrated reduced risk-adjusted mortality and complications in off-CPB coronary artery bypass grafting (CABG) using LISA compared to standard myocardial revascularization. From January to December 1997, 1210 patients underwent isolated CABG at our institution. Of these patients, 832 (63%) were scheduled as on-CPB cases and 378 (37%) as off-CPB. Of the off-CPB patients, 48 were converted to CPB. Team A surgeons used LISA as their primary strategy for CABG whereas team B surgeons used off-CPB CABG in selected patients. Conversions were divided in three classes: Class I patients were converted when the surgeon considered complete revascularization impossible off-CPB; Class II patients were converted due to hemodynamic instability during the procedure; and Class III patients were converted due to graft malfunction, determined by flow measurements or clinical evidence. There were four deaths. All had perioperative infarctions and required intra-aortic balloon pump (IABP). Conversion to CPB occurred in up to 25% of patients scheduled for off-CPB CABG. When off-CPB cases are done using the comprehensive LISA technique and modern technology, conversion rates may be reduced to 11%. Conversion is in general well tolerated except when it is instituted for graft malfunction combined with hemodynamic instability or collapse.
评估了在采用微创外科手术方法（LISA）进行心肌血运重建期间需要转为体外循环（CPB）的患者的手术结果。LISA是最近引入的一种无需CPB即可完成心肌血运重建的技术。它将避免使用CPB与正中胸骨切开术的多功能性相结合，以进入所有冠状动脉血管。我们之前已经证明，与标准心肌血运重建相比，使用LISA进行非体外循环冠状动脉旁路移植术（CABG）可降低风险调整后的死亡率和并发症。1997年1月至12月，我们机构有1210例患者接受了单纯CABG手术。在这些患者中，832例（63%）计划进行体外循环手术，378例（37%）计划进行非体外循环手术。在非体外循环患者中，有48例转为体外循环。A组外科医生将LISA作为他们进行CABG的主要策略，而B组外科医生在选定的患者中使用非体外循环CABG。转为体外循环分为三类：I类患者在外科医生认为非体外循环下无法完成完全血运重建时转为体外循环；II类患者因手术过程中血流动力学不稳定而转为体外循环；III类患者因移植物功能障碍（通过流量测量或临床证据确定）而转为体外循环。有4例死亡。所有患者均发生围手术期梗死，需要主动脉内球囊泵（IABP）。计划进行非体外循环CABG的患者中，高达25%的患者需要转为体外循环。当使用综合LISA技术和现代技术进行非体外循环手术时，转化率可能降至11%。一般来说，转为体外循环耐受性良好，除非是因移植物功能障碍合并血流动力学不稳定或衰竭而进行。
