Bolcal Cengiz, Emrecan Bilgin, Bingöl Hakan, Ayik Mehmet Fatih, Cingöz Faruk, Yildirim Vedat, Kuralay Erkan, Demirkiliç Ufuk, Kiliç Selim, Tatar Harun
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Heart Surg Forum. 2006;9(6):E866-70. doi: 10.1532/HSF98.20061100.
Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods.
This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared.
Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001).
The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.
冠状动脉旁路移植术（CABG）后出现的传导障碍可能有多种不同原因。在本研究中，我们针对顺行血液心脏停搏法和顺行加持续逆行心脏停搏法评估了CABG术后的传导障碍情况。
这项回顾性研究纳入了2001年1月至2005年12月期间接受CABG的1824例患者。其中女性患者694例（38%），男性患者1130例（62%）。采用等温高钾血液心脏停搏法进行心肌保护。第1组（n = 704）的患者仅使用间歇性顺行心脏停搏进行手术，第2组（n = 1120）的患者使用顺行加逆行持续心脏停搏进行手术。评估并比较术后新出现的右束支传导阻滞、左前分支阻滞、左后分支阻滞、左束支传导阻滞或三度房室传导阻滞的发生率。
总死亡率为1.6%（29例患者），两组之间无显著差异。两组的术前和围手术期特征在统计学上相似。第1组传导障碍的发生率显著更高（P = .006，55例对52例）。对传导障碍患者的分析显示，除了重症监护病房随访时间和术后住院时间显著增加外（P <.001），死亡率也显著增加（P < .001）。
本研究表明，顺行控制和逆行持续联合心脏停搏可降低CABG术后围手术期传导障碍的发生率。
