Dewey T M, Magee M J, Edgerton J R, Mathison M, Tennison D, Mack M J
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA.
Ann Thorac Surg. 2001 Sep;72(3):788-91; discussion 792. doi: 10.1016/s0003-4975(01)02839-9.
Because of a concern about the ability to tolerate beating heart grafting, patients with left main coronary artery stenosis have been excluded from off-pump bypass. We reviewed our experience with off-pump coronary artery bypass grafting for patients with left main coronary artery disease.
Eight hundred twenty-three patients underwent bypass grafting for left main coronary artery disease from January 1998 to October 1999. One hundred patients were revascularized without the use of cardiopulmonary bypass and compared with a contemporaneous cohort of 723 patients who underwent grafting with the aid of cardiopulmonary bypass. All patients had multivessel grafting performed through a sternotomy.
There was one death (1%) in the group undergoing off-pump grafting as compared with a 30-day mortality of 4.7% (p = 0.059) in the on-pump group. Univariate analysis established that patients revascularized without cardiopulmonary bypass were significantly less likely to require postoperative inotropic support (23% versus 62%, p < 0.001) and transfusion (35% versus 67%, p < 0.001). Logistic regression analysis revealed that cardiopulmonary bypass was an independent risk factor for mortality (odds ratio, 7.3; 95% confidence interval, 1.34 to 138.4).
Coronary artery bypass grafting using off-pump techniques are safe and effective in left main coronary artery disease.
由于担心对心脏不停跳移植的耐受性，左主冠状动脉狭窄患者被排除在非体外循环搭桥手术之外。我们回顾了我们对左主冠状动脉疾病患者进行非体外循环冠状动脉搭桥手术的经验。
1998年1月至1999年10月，823例患者接受了左主冠状动脉疾病的搭桥手术。其中100例患者在未使用体外循环的情况下进行了血运重建，并与同期723例在体外循环辅助下进行搭桥手术的患者进行了比较。所有患者均通过胸骨切开术进行多支血管搭桥。
非体外循环搭桥组有1例死亡（1%），而体外循环组30天死亡率为4.7%（p = 0.059）。单因素分析表明，未使用体外循环进行血运重建的患者术后需要使用正性肌力药物支持的可能性显著降低（23%对62%，p < 0.001），输血的可能性也显著降低（35%对67%，p < 0.001）。逻辑回归分析显示，体外循环是死亡的独立危险因素（比值比，7.3；95%置信区间，1.34至138.4）。
采用非体外循环技术进行冠状动脉搭桥手术在左主冠状动脉疾病中是安全有效的。
