Dagenais F, Perrault L P, Cartier R, Searle N, Pagé P, Pellerin M, Pelletier L C, Carrier M
Montreal Heart Institute, Montreal, Canada.
Can J Cardiol. 1999 Aug;15(8):867-72.
To describe the initial experience of the first 200 patients who underwent coronary artery bypass grafting (CABG) on beating hearts at the Montreal Heart Institute, Montreal.
A prospective cohort of 200 patients was analyzed to study immediate and short term (two-year follow-up) results.
Patients underwent CABG at the Montreal Heart Institute from February 1996 to June 1998. The first 30 patients underwent CABG without the use of a myocardial wall stabilizer (group 1), and a myocardial wall stabilizer was used in the following 170 patients (group 2).
Group 1 patients averaged 60+/-10 years of age compared with 66+/-10 years in group 2 (P=0.002). Twelve patients (40%) in group 1 had unstable angina compared with 107 patients (63%) in group 2 (P=0.03).
Group 1 patients underwent 1.7+/-0.7 CABG per patient compared with 2.4+/-0.8 grafts per patient in group 2 (P=0.001). Sixty-seven patients (39%) in group 2 had an obtuse marginal coronary artery grafted, and 145 patients (73%) of both groups had a complete myocardial revascularization.
Ten patients (5%) in both groups were converted to cardiopulmonary bypass during surgery. Seven patients (3.5%) died postoperatively: five from myocardial infarction, one from aortic dissection and rupture, and one from arrhythmia. Seventeen patients (8.5%) suffered a perioperative myocardial infarction. In groups 1 and 2, respectively, actuarial survival was 100% and 95+/-2%, and freedom rate from reoperation, percutaneous balloon dilation and recurrent myocardial infarction averaged 93+/-4% and 97+/-2% 18 months following CABG.
CABG on beating hearts appears to be an alternative approach to the use of cardiopulmonary bypass in selected patients.
描述蒙特利尔心脏研究所首批200例接受心脏不停跳冠状动脉搭桥术（CABG）患者的初始经验。
对200例患者的前瞻性队列进行分析，以研究即刻和短期（两年随访）结果。
1996年2月至1998年6月期间，患者在蒙特利尔心脏研究所接受CABG手术。前30例患者在不使用心肌壁稳定器的情况下接受CABG手术（第1组），随后的170例患者使用了心肌壁稳定器（第2组）。
第1组患者平均年龄为60±10岁，而第2组为66±10岁（P = 0.002）。第1组中有12例患者（40%）患有不稳定型心绞痛，而第2组中有107例患者（63%）患有不稳定型心绞痛（P = 0.03）。
第1组患者人均接受1.7±0.7次CABG手术，而第2组患者人均接受2.4±0.8次移植手术（P = 0.001）。第2组中有67例患者（39%）进行了钝缘支冠状动脉移植，两组中有145例患者（73%）实现了完全心肌血运重建。
两组中均有10例患者（5%）在手术期间转为体外循环。7例患者（3.5%）术后死亡：5例死于心肌梗死，1例死于主动脉夹层和破裂，1例死于心律失常。17例患者（8.5%）发生围手术期心肌梗死。在CABG术后18个月，第1组和第2组的精算生存率分别为100%和95±2%，再次手术、经皮球囊扩张和复发性心肌梗死的免发生率平均分别为93±4%和97±2%。
心脏不停跳CABG似乎是在特定患者中替代使用体外循环的一种方法。
