Bolotin Gil, Shapira Yuval, Gotler Yakov, Frolkis Inna V, Ben-Gal Yanai, Nesher Nahum, Uretzky Gideon
The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv, 64239, Israel.
Int J Cardiol. 2007 Jan 2;114(1):11-5. doi: 10.1016/j.ijcard.2005.11.107. Epub 2006 May 9.
Off-pump coronary artery bypass grafting (OPCAB) and complete arterial revascularization without proximal anastomosis to the aorta may decrease neurological events after open-heart surgery. Few reports exist regarding the combination of OPCAB and complete arterial revascularization exploring the theoretical advantage of avoiding manipulation of the aorta. We review our results in 110 patients who underwent multiple grafts off-pump complete arterial revascularization.
110 patients underwent multiple grafts OPCAB complete arterial revascularization, and were compared to 216 patients who underwent traditional multiple grafts on pump CABG. Preoperative renal failure was 12.7% (n=14) as compared to 5.1%, (n=11, p=0.01) in the control group and 33.6% (n=37) of the patients were 75 years or older as compared to 19.0% (n=41, p=0.003) in the control group.
The mean number of grafts per patient undergoing multiple OPCAB complete arterial revascularization was 2.3, as compared to 3.11 in the control group (p<0.001). The mortality rate was 2.73% as compared to 1.85% (NS) in the control group. The incidence of CVA was 0% as compared to 2.31% (p=0.17) in the control group.
Complete arterial OPCAB revascularization without manipulation of the aorta in high-risk patients can be performed with short-term similar results to conventional CABG and very low neurological complications.
非体外循环冠状动脉旁路移植术（OPCAB）以及不与主动脉进行近端吻合的完全动脉血运重建术可能会降低心脏直视手术后的神经系统事件发生率。关于OPCAB与完全动脉血运重建术相结合以探索避免主动脉操作的理论优势的报道较少。我们回顾了110例行非体外循环下多支血管完全动脉血运重建术患者的结果。
110例行非体外循环下多支血管完全动脉血运重建术的患者与216例行传统体外循环下多支血管冠状动脉旁路移植术（CABG）的患者进行比较。术前肾衰竭发生率为12.7%（n = 14），而对照组为5.1%（n = 11，p = 0.01）；33.6%（n = 37）的患者年龄在75岁及以上，而对照组为19.0%（n = 41，p = 0.003）。
行非体外循环下多支血管完全动脉血运重建术的患者平均每例移植血管数为2.3支，而对照组为3.11支（p < 0.001）。死亡率为2.73%，而对照组为1.85%（无统计学差异）。脑血管意外（CVA）发生率为0%，而对照组为2.31%（p = 0.17）。
在高危患者中，不进行主动脉操作的完全动脉化OPCAB血运重建术可获得与传统CABG相似的短期效果，且神经系统并发症极低。
