Hirose Hitoshi
Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.
Cardiology. 2004;101(4):194-8. doi: 10.1159/000076696. Epub 2004 Feb 12.
Multivessel off-pump coronary artery bypass grafting (CABG) has been performed with favorable results in our institute. In this study, we analyzed the outcomes in patients who underwent off-pump CABG for left main disease, since the surgical outcomes for such patients have not been clarified.
Between March 1, 1999 and July 30, 2002, a total of 147 patients with left main disease (112 males and 35 females, mean age 66.9 +/- 9.8 years) underwent off-pump CABG. Perioperative and follow-up data were entered into a structured database and the results were analyzed.
Urgent or emergent surgery was performed in 25 patients (17.0%), and a preoperative intra-aortic balloon pump was used in 12 patients (8.2%). The mean number of bypass grafts was 3.2 +/- 1.0, and complete revascularization was performed in 127 patients (86.4%). There were 4 incidences of intraoperative conversion from off-pump to on-pump surgery. The mean intubation period, intensive care unit stay and postoperative hospital stay were 9.4 +/- 13.0 h, 2.3 +/- 1.4 days and 13.4 +/- 7.3 days, respectively. There was 1 hospital death (0.7%). Postoperative myocardial infarction was observed in 2 patients (1.4%), postoperative stroke in 1 (0.7%), prolonged ventilator support in 5 (3.4%) and mediastinitis in 3 (2.0%). During the follow-up period of 2.1 +/- 1.0 years, there were 4 deaths and 7 cardiac events. The actuarial 3-year survival rate was 97.0%, and the event-free rate was 94.3%.
Our observations support off-pump CABG as a surgical option with a favorable outcome for patients with left main disease.
在我们研究所，多支血管非体外循环冠状动脉旁路移植术（CABG）已取得良好效果。在本研究中，我们分析了接受非体外循环CABG治疗左主干病变患者的手术结果，因为此类患者的手术结果尚未明确。
在1999年3月1日至2002年7月30日期间，共有147例左主干病变患者（男性112例，女性35例，平均年龄66.9±9.8岁）接受了非体外循环CABG。围手术期和随访数据录入结构化数据库并进行结果分析。
25例患者（17.0%）进行了急诊或紧急手术，12例患者（8.2%）术前使用了主动脉内球囊泵。平均搭桥数量为3.2±1.0，127例患者（86.4%）实现了完全血运重建。有4例术中从非体外循环转为体外循环手术。平均插管时间、重症监护病房停留时间和术后住院时间分别为9.4±13.0小时、2.3±1.4天和13.4±7.3天。有1例医院死亡（0.7%）。2例患者（1.4%）发生术后心肌梗死，1例（0.7%）发生术后卒中，5例（3.4%）需要延长呼吸机支持，3例（2.0%）发生纵隔炎。在2.1±1.0年的随访期内，有4例死亡和7例心脏事件。3年实际生存率为97.0%，无事件生存率为94.3%。
我们的观察结果支持非体外循环CABG作为左主干病变患者的一种手术选择，其手术效果良好。
