Arom K V, Flavin T F, Emery R W, Kshettry V R, Petersen R J, Janey P A
Cardiac Surgical Associates, Minneapolis, Minnesota 55407, USA.
Ann Thorac Surg. 2000 Sep;70(3):1021-5. doi: 10.1016/s0003-4975(00)01761-6.
Does the manipulation of the heart during off-pump coronary artery bypass (OPCAB) procedure further compromise the hemodynamic stability of a patient with depressed left ventricular function compared with the conventional coronary artery bypass (CCAB) approach? Does this manipulation induce a more dramatic hypoperfused state that may contribute to an increase in the incidence of related complications or mortality? This retrospective review of data attempted to answer the above concern.
Between January 1, 1998, and June 30, 1999, 177 patients with ejection fractions of 30% or less underwent full sternotomy coronary artery bypass grafting at our institution. Of these patients, 45 underwent OPCAB procedures and 132 patients underwent CCAB. Pre-, intra-, and postoperative variables as identified by The Society of Thoracic Surgeons National Cardiac Surgery Database were compared using univariate and logistical regression analysis.
Despite recognized hemodynamic derangement during cardiac displacement, these groups of OPCAB patients appeared to tolerate the procedure well. Univariate analysis of cardiac enzyme leak and blood loss was statistically significant in the OPCAB patients. Utilizing regression analysis, cardiopulmonary bypass was the only predictor for all postoperative complications.
Multivessel coronary artery bypass utilizing the OPCAB approach in patients with depressed left ventricular function of equal to or less than 30% is appropriate and applicable. Analysis of CCAB and OPCAB variables was nonsignificant except for operative and postoperative blood loss and peak cardiac enzyme leak. Attention to intraoperative detail and hemodynamic management could be credited for the success with OPCAB.
与传统冠状动脉搭桥术（CCAB）相比，非体外循环冠状动脉搭桥术（OPCAB）过程中对心脏的操作是否会进一步损害左心室功能不全患者的血流动力学稳定性？这种操作是否会引发更严重的灌注不足状态，从而可能导致相关并发症发生率或死亡率增加？这项数据回顾性研究试图回答上述问题。
1998年1月1日至1999年6月30日期间，177例射血分数为30%或更低的患者在我院接受了全胸骨切开冠状动脉搭桥术。其中，45例接受了OPCAB手术，132例接受了CCAB手术。使用单因素分析和逻辑回归分析比较了胸外科医师协会国家心脏手术数据库确定的术前、术中和术后变量。
尽管术中确认心脏移位期间存在血流动力学紊乱，但这些OPCAB患者组似乎对该手术耐受良好。OPCAB患者心脏酶泄漏和失血的单因素分析具有统计学意义。利用回归分析，体外循环是所有术后并发症的唯一预测因素。
对于左心室功能等于或低于30%的患者，采用OPCAB方法进行多支冠状动脉搭桥术是合适且可行的。除了手术中和术后失血以及心脏酶峰值泄漏外，CCAB和OPCAB变量分析无显著差异。OPCAB手术的成功可能归功于对术中细节和血流动力学管理的关注。
