Naseri Erdinç, Sevinç Meral, Erk M Kamuran
Department of Thoracic and Cardiovascular Surgery, Academic Hospital, Istanbul, Turkey.
Heart Surg Forum. 2003;6(4):216-9.
This study was designed to compare the early and midterm results of off-pump coronary endarterectomy (OPCE) with those of conventional coronary endarterectomy (CCE) performed with cardiopulmonary bypass.
From April 1, 1999, until March 1, 2001, 332 patients underwent off-pump coronary artery bypass grafting at our institution. From this total, 44 (13%) of the patients underwent supplementary OPCE (group 1). The results were compared with those for a group of age-, sex-, and risk factor-matched patients undergoing CCE (group 2) at the same institution. The mean follow-up period was 16 months. The indications for operation in group 1 were angina in 16 (36%) of the cases, cardiac failure in 20 (45%), and prognosis in 8 (19%). In group 2 angina was the indication for operation in 11 (25%) of the cases, cardiac failure in 5 (11%), and prognosis in 30 (64%) of the cases.
In group 1, 35 patients underwent single and 9 underwent double endarterectomy. The procedures included 32 right coronary artery, 12 left anterior descending artery, 2 lateral circumflex artery, and 7 diagonal branch operations. Three (6.8%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 developed postoperative myocardial infarction (P <.05). One (2.2%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 died in the postoperative period (P <.05). The numbers of patients with perioperative neurologic deficit in groups 1 and 2 were 0 and 7, respectively (P <.001). Although the rate of perioperative myocardial infarction was higher in group 1, mortality, occurrence of other morbid events, intubation time, intensive care stay, and hospital length of stay were less in group 1 than group 2.
OPCE can be performed safely with morbidity and mortality comparable with those of CCE.
本研究旨在比较非体外循环冠状动脉内膜切除术（OPCE）与体外循环下传统冠状动脉内膜切除术（CCE）的早期和中期结果。
1999年4月1日至2001年3月1日，我院332例患者接受了非体外循环冠状动脉搭桥术。其中，44例（13%）患者接受了补充性OPCE（第1组）。将结果与同一机构中一组年龄、性别和危险因素相匹配的接受CCE的患者（第2组）进行比较。平均随访期为16个月。第1组的手术指征为16例（36%）心绞痛、20例（45%）心力衰竭和8例（19%）预后。第2组中，11例（25%）患者的手术指征为心绞痛，5例（11%）为心力衰竭，30例（64%）为预后。
第1组中，35例患者接受了单支内膜切除术，9例接受了双支内膜切除术。手术包括32例右冠状动脉、12例左前降支动脉、2例左旋支动脉和7例对角支手术。第1组3例（6.8%）患者和第2组2例（4.4%）患者发生术后心肌梗死（P<.05）。第1组1例（2.2%）患者和第2组2例（4.4%）患者术后死亡（P<.05）。第1组和第2组围手术期神经功能缺损患者数分别为0例和7例（P<.001）。虽然第1组围手术期心肌梗死发生率较高，但第1组的死亡率、其他不良事件发生率、插管时间、重症监护停留时间和住院时间均低于第2组。
OPCE可安全进行，其发病率和死亡率与CCE相当。
