Takriti S A, Hindaoui R, Jouma M, Bitar M S
Al-Assad University Hospital, Syria.
Int J Surg Investig. 1999;1(4):271-6.
Coronary artery bypass grafting (CABG) operations in connection with cardiopulmonary bypass (CPB) appear to be associated with a number of side effects including trauma, cognitive dysfunction and myocardial damage. Accordingly, a current interest in performing CABG on a beating heart begins to emerge. This study examines the premise that conducting CABG on a beating heart limits the extent of myocardial injury and other complications.
Forty-five consecutive patients underwent CABG on a beating heart (group A, 12 patients) or in connection with CPB (group B, 33 patients). Inclusion criteria were poor left ventricular function and evolving myocardial ischemia or infarction. Results were assessed primarily on the basis of clinical outcome. In addition, measurement of plasma levels of troponin T (TnT), creatine kinase MB (CK-MB) and lactate dehydrogenase (LD) was conducted in 12 patients of group A preoperatively and 24 h after completion of surgery. These biological data were compared with those from control patients who underwent CABG in connection with CPB within the same time span.
All patients in groups A and B survived the CABG procedure and those on a beating heart maintained an excellent perioperative hemodynamic measurements. The mean bypass time was 75 +/- 21 min and the mean cardiac standstill was 40 +/- 17 min. The intensive care unit stay was for group A: 18 +/- 4 h, group B: 48 +/- 12 h; and the total hospital stay was for group A: 6 +/- 1 days, group B: 8 +/- 3 days. Angiographic studies showed good anastomatic patency in both groups. Postoperative low output syndrome as indicated by the need of ionotropic drugs for more than 24 h was demonstrated in 4% and 6% of groups A and B, respectively. Limitation of myocardial injury in group A was demonstrated by the minimal increase in postoperative TnT levels (16.0 +/- 0.9 versus 30 +/- 8.0 pg/ml). A similar pattern of changes was observed with other infarction markers including CK-MB and LD. Contrastingly, the pre- and post-operative values of TnT in group B were 18 +/- 1.6 and 790 +/- 140 pg/ml, respectively.
CABG on a beating heart shares many of the positive features of CPB with a distinct advantage of eliminating the intraoperative myocardial ischemia.
冠状动脉旁路移植术（CABG）与体外循环（CPB）相关的手术似乎会引发多种副作用，包括创伤、认知功能障碍和心肌损伤。因此，目前对在跳动心脏上进行CABG的兴趣开始显现。本研究探讨在跳动心脏上进行CABG可限制心肌损伤程度及其他并发症这一前提。
45例连续患者接受了在跳动心脏上的CABG（A组，12例患者）或与CPB相关的CABG（B组，33例患者）。纳入标准为左心室功能差以及正在发展的心肌缺血或梗死。主要根据临床结果评估疗效。此外，对A组12例患者在术前及手术完成后24小时测量血浆肌钙蛋白T（TnT）、肌酸激酶MB（CK-MB）和乳酸脱氢酶（LD）水平。将这些生物学数据与同期接受与CPB相关CABG的对照患者的数据进行比较。
A组和B组所有患者均在CABG手术中存活，且跳动心脏组患者围手术期血流动力学测量结果良好。平均体外循环时间为75±21分钟，平均心脏停搏时间为40±17分钟。重症监护病房停留时间A组为18±4小时，B组为48±12小时；总住院时间A组为6±1天，B组为8±3天。血管造影研究显示两组吻合口通畅良好。A组和B组分别有4%和6%的患者出现术后需要使用血管活性药物超过24小时所提示的低心排血量综合征。A组术后TnT水平升高幅度最小（16.0±0.9对30±8.0 pg/ml），证明心肌损伤受到限制。其他梗死标志物包括CK-MB和LD也观察到类似的变化模式。相比之下，B组术前和术后TnT值分别为18±1.6和790±140 pg/ml。
在跳动心脏上进行CABG具有CPB的许多积极特征，其独特优势是消除术中心肌缺血。
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