Vohra Hunaid A, Kanwar Raj, Khan Tanveer, Dimitri Wade R
Department of Cardiothoracic Surgery, Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom.
Ann Thorac Surg. 2006 May;81(5):1691-6. doi: 10.1016/j.athoracsur.2005.12.028.
We aimed to review the early and late results of off-pump coronary artery bypass graft surgery (OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution.
Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice (W.R.D.), 70 patients (10.29%) who underwent concomitant coronary endarterectomy were studied. The mean age was 63.6 +/- 9.29 years. Thirty-three patients (55%) were Canadian Cardiovascular Society class III or IV, and 24 patients (40%) were New York Heart Association class III or IV. Eighteen patients (35%) had impaired left ventricular function. The mean EuroSCORE of these patients was 5.9 +/- 1.8.
Fifty-seven patients (81%) underwent right coronary artery endarterectomy, and 12 patients (17%) underwent left anterior descending artery endarterectomy (8 left interior mammary arteries used as conduits). Four patients (5.7%) had two vessels endarterectomized. The mean number of grafts were 2.0 +/- 0.4. The 30-day mortality rate was 2.85% (n = 2). Three patients (4.3%) suffered from postoperative myocardial infarction, and 3 patients (4.3%) required postoperative intra-aortic balloon pump counterpulsation. Mean intensive therapy unit stay was 17.6 +/- 8.1 hours. Patients were extubated after a mean of 10.38 +/- 4.9 hours. The mean length of hospital stay was 6.1 +/- 2.0 days. Fourteen patients (20%) had postoperative atrial fibrillation, and only 1 patient (1.42%) had a transient stroke with complete recovery. There were no conversions to cardiopulmonary bypass. A mean of 0.86 +/- 0.17 units of blood were transfused postoperatively. There was one reopening for bleeding, and 1 patient had renal failure requiring hemofiltration. The median follow-up was 4.91 years, 90% of patients were angina free, and the actuarial survival at 10 years was 78.04% +/- 7.6%.
Off-pump coronary artery bypass graft survery with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse coronary artery disease.
我们旨在回顾我院接受外科血运重建术的患者，在非体外循环冠状动脉旁路移植术（OPCABG）联合冠状动脉内膜切除术治疗后的早期和晚期结果。
1995年至2004年间，在一位外科医生（W.R.D.）实施的680例OPCABG患者中，对70例（10.29%）同期接受冠状动脉内膜切除术的患者进行了研究。平均年龄为63.6±9.29岁。33例（55%）患者为加拿大心血管学会III或IV级，24例（40%）患者为纽约心脏协会III或IV级。18例（35%）患者左心室功能受损。这些患者的平均欧洲心脏手术风险评估系统（EuroSCORE）评分为5.9±1.8。
57例（81%）患者接受了右冠状动脉内膜切除术，12例（17%）患者接受了左前降支动脉内膜切除术（8例使用左内乳动脉作为移植血管）。4例（5.7%）患者有两支血管接受了内膜切除术。平均移植血管数量为2.0±0.4。30天死亡率为2.85%（n = 2）。3例（4.3%）患者发生术后心肌梗死，3例（4.3%）患者术后需要主动脉内球囊反搏。平均重症监护病房停留时间为17.6±8.1小时。患者平均在10.38±4.9小时后拔除气管插管。平均住院时间为6.1±2.0天。14例（20%）患者发生术后房颤，只有1例（1.42%）患者发生短暂性卒中且完全恢复。无一例转为体外循环。术后平均输血0.86±0.17单位。有1例因出血再次手术，1例患者发生肾衰竭需要血液滤过。中位随访时间为4.91年，90%的患者无心绞痛，10年实际生存率为78.04%±7.6%。
非体外循环冠状动脉旁路移植术联合冠状动脉内膜切除术是可行的，能够实现弥漫性冠状动脉疾病患者的外科血运重建。
