Czerny M, Baumer H, Kilo J, Zuckermann A, Grubhofer G, Chevtchik O, Wolner E, Grimm M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Austria.
Ann Thorac Surg. 2001 Jan;71(1):165-9. doi: 10.1016/s0003-4975(00)02230-x.
The feasibility of complete revascularization on the beating heart without cardiopulmonary bypass (CPB) as compared with the standard operation with CPB in elective low-risk patients with multivessel disease has not been clearly demonstrated in a prospective trial.
Eighty selected low-risk patients were enrolled. In preoperative study with coronary angiography, the decision was made whether complete revascularization without CPB could be performed. Patients were randomly assigned to receive CABG either with (n = 40) or without CPB (n = 40). Randomization criteria were age, sex, and left ventricular ejection fraction. Completeness of revascularization as well as short- and mid-term clinical outcome in a 13.4 +/- 6.5 month follow-up period were monitored.
Twenty-six of 40 (65%) patients undergoing CABG without CPB underwent complete revascularization. In 5 of these patients (12.5%) suitable vessels were discarded for technical reasons and 9 patients (22.5%) were switched to CABG with CPB owing to the deeply intramyocardial course of target vessels (n = 5) or to hemodynamic instability (n = 4). In the group of patients operated on with CPB, 34 of 40 patients (85%) received complete revascularization. In 6 patients (15%) suitable vessels were discarded for technical reasons. Mean number of bypass grafts was 3.1 +/- 0.8 with CPB and 2.6 +/- 0.5 without CPB (p = 0.043). Clinical outcome and hospital stay were comparable in both groups. No patient died during the study period. No myocardial infarction was observed. Three patients undergoing CABG without CPB underwent successful PTCA 3 months after surgery.
CABG without the use of CPB is effective for complete revascularization in the majority of selected low-risk patients. Nevertheless, it has to be stated that the rate of incomplete revascularization in this early series of CABG without CPB is higher, and compromises the basic principle of complete revascularization.
在择期低风险多支血管病变患者中，与使用体外循环（CPB）的标准手术相比，不停跳心脏完全血运重建的可行性尚未在前瞻性试验中得到明确证实。
选取80例低风险患者。在术前进行冠状动脉造影研究时，确定是否可以进行不停跳心脏完全血运重建。患者被随机分配接受有（n = 40）或无CPB（n = 40）的冠状动脉旁路移植术（CABG）。随机化标准为年龄、性别和左心室射血分数。在13.4±6.5个月的随访期内监测血运重建的完整性以及短期和中期临床结局。
40例接受不停跳CABG的患者中有26例（65%）实现了完全血运重建。其中5例患者（12.5%）因技术原因放弃了合适的血管，9例患者（22.5%）因靶血管走行于心肌深层（n = 5）或血流动力学不稳定（n = 4）而转为接受CPB辅助的CABG。在接受CPB辅助手术的患者组中，40例患者中有34例（85%）实现了完全血运重建。6例患者（15%）因技术原因放弃了合适的血管。使用CPB时平均搭桥血管数为3.1±0.8，不使用CPB时为2.6±0.5（p = 0.043）。两组的临床结局和住院时间相当。研究期间无患者死亡。未观察到心肌梗死。3例接受不停跳CABG的患者术后3个月成功进行了经皮冠状动脉腔内血管成形术（PTCA）。
对于大多数选定的低风险患者，不使用CPB的CABG对于完全血运重建是有效的。然而，必须指出的是，在这一早期的不停跳CABG系列中，不完全血运重建的发生率较高，这违背了完全血运重建的基本原则。
