Hirose Hitoshi, Amano Atushi, Takahashi Akihito, Takanashi Shuichirou
Department of Cardiovascular Surgery, Kobari General Hospital, 29-1 Yokouchi, Noda City, Chiba 278-8501, Japan.
Jpn J Thorac Cardiovasc Surg. 2002 Aug;50(8):330-7. doi: 10.1007/BF03032626.
The use of off-pump coronary artery bypass grafting (CABG) has become widespread, since it has proven less invasive and to promote early recovery. In this study, we investigated the efficacy of off-pump CABG in patients in the evolving phase of acute myocardial infarction.
Retrospective chart review was carried out for patients undergoing urgent isolated off-pump and on-pump CABG at Shin-Tokyo Hospital Group between January 1991 and June 2001. The patients' demographic, operative data, and postoperative results were collected.
The off-pump group consisted of 19 males and 11 females with a mean age of 72.0 years and the on-pump group of 91 males and 38 females with a mean age of 64.3 years. Preoperative use of intraaortic balloon pumping and preoperative shock was more frequently observed in the on-pump group. The mean number of distal anastomoses was 3.1 +/- 0.9 in the off-pump group and 3.2 +/- 1.1 in the on-pump group (p = NS). Intubation time (18.5 vs 32.9 hours), ICU stay (3.4 vs 4.9 days), and postoperative stay (13.5 vs 24.3 days) were significantly shorter in the off-pump group than in the on-pump group (P < 0.05). The frequency of the major complications was significantly lower in the off-pump group (9/30, 30%) than the on-pump group (65/129, 50.4%), especially for postoperative low output syndrome (p < 0.05). Multivariate analysis demonstrated a significant reduction in the recovery period by use of off-pump CABG. Early follow-up results were similar between the two groups, in terms of late cardiac events and survival.
Urgent off-pump CABG is safe and provides early recovery, provided that the patient's intraoperative hemodynamics are taken into account.
非体外循环冠状动脉旁路移植术（CABG）已广泛应用，因为它已被证明创伤性较小且能促进早期恢复。在本研究中，我们调查了非体外循环CABG在急性心肌梗死进展期患者中的疗效。
对1991年1月至2001年6月期间在新东京医院集团接受紧急单纯非体外循环和体外循环CABG的患者进行回顾性病历审查。收集患者的人口统计学、手术数据和术后结果。
非体外循环组包括19名男性和11名女性，平均年龄72.0岁；体外循环组包括91名男性和38名女性，平均年龄64.3岁。体外循环组更常观察到术前使用主动脉内球囊反搏和术前休克。非体外循环组远端吻合的平均数量为3.1±0.9，体外循环组为3.2±1.1（p =无显著性差异）。非体外循环组的插管时间（18.5小时对32.9小时）、重症监护病房停留时间（3.4天对4.9天）和术后住院时间（13.5天对24.3天）明显短于体外循环组（P < 0.05）。非体外循环组主要并发症的发生率（9/30，30%）明显低于体外循环组（65/129，50.4%），尤其是术后低心排血量综合征（p < 0.05）。多因素分析表明，使用非体外循环CABG可显著缩短恢复期。两组的早期随访结果在晚期心脏事件和生存率方面相似。
紧急非体外循环CABG是安全的，并能促进早期恢复，前提是要考虑患者术中的血流动力学情况。
