灌注辅助直接冠状动脉搭桥术可实现缺血心肌的早期再灌注，并有助于实现完全血运重建。

Cooper William A, Corvera Joel S, Thourani Vinod H, Puskas John D, Craver Joseph M, Lattouf Omar M, Guyton Robert A

The Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.

Ann Thorac Surg. 2003 Apr;75(4):1132-9. doi: 10.1016/s0003-4975(02)04651-9.

BACKGROUND

Perfusion-assisted direct coronary artery bypass (PADCAB) was developed to initiate early reperfusion of grafted coronary artery segments during off-pump operations to resolve episodes of myocardial ischemia and avoid its sequelae. This case series outlines intraoperative findings and clinical outcomes of our first year clinical experience with PADCAB.

METHODS

From November 1999 to November 2000, 169 PADCAB and 358 off-pump coronary artery bypass procedures were performed at the Emory University Hospitals. The decision to use PADCAB was predicated on surgeon preference. Perfusion pressure and flow, amount of intracoronary nitroglycerin, and total perfusion time and volume were recorded at the time of operation.

RESULTS

One off-pump coronary artery bypass patient required emergent conversion to cardiopulmonary bypass. Two PADCAB patients had ischemic ventricular arrhythmias during target vessel occlusion that resolved once active perfusion had begun. Perfusion pressure in PADCAB grafts was on average 44% higher than mean arterial pressure (p < 0.001). Nitroglycerin, infused locally by PADCAB, was used in 67 patients to resolve ischemic episodes and increase initial coronary flows. The mean number of diseased coronary territories and grafts placed was 2.8 +/- 0.5 and 3.4 +/- 0.7, respectively, in the PADCAB group, and 2.3 +/- 0.8 and 2.7 +/- 1.0, respectively, in the off-pump coronary artery bypass group (p < 0.001 for both comparisons). More PADCAB patients received lateral wall grafts than off-pump coronary artery bypass patients (83.4% vs 59.4%; p < 0.001). Hospital death and postoperative myocardial infarction were not different between groups.

CONCLUSIONS

PADCAB can provide suprasystemic perfusion pressures and a means to add vasoactive drugs to target coronary vessels. PADCAB provides early reperfusion of ischemic myocardium and facilitates complete revascularization of severe multivessel coronary artery disease.

背景

灌注辅助直接冠状动脉旁路移植术（PADCAB）的研发目的是在非体外循环手术期间实现移植冠状动脉节段的早期再灌注，以解决心肌缺血发作并避免其后遗症。本病例系列概述了我们第一年PADCAB临床经验的术中发现和临床结果。

方法

1999年11月至2000年11月，埃默里大学医院进行了169例PADCAB和358例非体外循环冠状动脉旁路移植手术。使用PADCAB的决定取决于外科医生的偏好。手术时记录灌注压力和流量、冠状动脉内硝酸甘油用量、总灌注时间和体积。

结果

1例非体外循环冠状动脉旁路移植患者需要紧急转为体外循环。2例PADCAB患者在靶血管闭塞期间出现缺血性室性心律失常，一旦开始主动灌注即得到缓解。PADCAB移植物中的灌注压力平均比平均动脉压高44%（p<0.001）。67例患者使用PADCAB局部输注硝酸甘油来解决缺血发作并增加初始冠状动脉血流。PADCAB组平均病变冠状动脉区域数和移植血管数分别为2.8±0.5和3.4±0.7，非体外循环冠状动脉旁路移植组分别为2.3±0.8和2.7±1.0（两组比较p均<0.001）。接受侧壁移植的PADCAB患者比非体外循环冠状动脉旁路移植患者多（83.4%对59.4%；p<0.001）。两组间医院死亡率和术后心肌梗死无差异。