Bergsland J, Schmid S, Yanulevich J, Hasnain S, Lajos T Z, Salerno T A
The Center for Less Invasive Cardiac Surgery, State University of New York at Buffalo and Buffalo General Hospital, 100 High Street, Buffalo, New York, NY 14203, USA.
Heart Surg Forum. 1998;1(2):107-10.
Coronary artery bypass grafting (CABG) was performed on patients with cardiopulmonary bypass (CPB group) or without CPB (non-CPB group). A series of CABG patients, performed between January 1, 1995 and September 30, 1997 is included.
Data were collected and analyzed as determined by the New York State Department of Health. Preoperative comorbidity, postoperative morbidity and mortality were compared. There were 2869 patients in the CPB group and 505 patients in the non-CPB group.
Demographics of the two groups were similar but preoperative risk factors were more common in patients undergoing CABG without CPB. Of the non-CPB patients, 31.9% had reoperations as compared to 8.5% in CPB patients (p = 0.00005). The presence of an extensively calcified aorta was more common in the non-CPB patients (5.9% vs. 2.8%, p = 0.0002). Immune deficiency was also more common in the non-CPB group (p = 0.001). Risk-adjusted mortality was similar in the two groups while major complications were much less common when CPB was not utilized. In CPB patients only 84.3% avoided major complications, while among non-CPB patients 90.1% were complication-free (p = 0.0008).
CABG without CPB is an attractive method of surgical revascularization. Increasing age and preoperative comorbidity in patients referred for CABG dictate changes in surgical strategy, of which avoidance of CPB appears most beneficial.
对接受体外循环的患者（体外循环组）或未接受体外循环的患者（非体外循环组）进行冠状动脉旁路移植术（CABG）。纳入了1995年1月1日至1997年9月30日期间进行的一系列CABG患者。
按照纽约州卫生部的规定收集和分析数据。比较术前合并症、术后发病率和死亡率。体外循环组有2869例患者，非体外循环组有505例患者。
两组的人口统计学特征相似，但术前危险因素在未接受体外循环的CABG患者中更为常见。在非体外循环患者中，31.9%进行了再次手术，而体外循环患者中这一比例为8.5%（p = 0.00005）。广泛钙化的主动脉在非体外循环患者中更常见（5.9%对2.8%，p = 0.0002）。免疫缺陷在非体外循环组中也更常见（p = 0.001）。两组的风险调整死亡率相似，但不使用体外循环时主要并发症要少得多。在体外循环患者中，只有84.3%避免了主要并发症，而非体外循环患者中有90.1%无并发症（p = 0.0008）。
非体外循环CABG是一种有吸引力的手术血运重建方法。接受CABG的患者年龄增加和术前合并症促使手术策略发生改变，其中避免体外循环似乎最有益。
