Fujii Takeshiro, Watanabe Yoshinori, Shiono Noritsugu, Kawasaki Muneyasu, Yokomuro Hiroki, Ozawa Tsukasa, Hamada Satoshi, Masuhara Hiroshi, Teramoto Tetsuo, Hara Masanori, Katayanagi Tomonori, Sasaki Yuki, Koyama Nobuya
Division of Cardiovascular Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2006 Oct;12(5):324-32.
To clarify the position of on-pump beating coronary artery bypass (CAB) and to define preoperative indicators of intentional conversion to the procedure in the era of advancement of off-pump CAB (OPCAB), we assessed on-pump beating CAB performed after the introduction of OPCAB.
We assessed 130 patients who underwent single CAB [117 (90%) with OPCAB and 13 (10%) with on-pump beating CAB] between August 1999 (when OPCAB was selected as the first-line surgical procedure) and December 2004.
No significant differences were seen between the groups in the number of coronary lesions or the prevalence of left main trunk (LMT) lesion. Reduced left cardiac function, cardiac dilatation, and mitral regurgitation (MR) were more remarkable in the on-pump beating CAB group. Preoperative ischemic condition was generally unstable in the both groups. A conversion to on-pump beating CAB occurred at anastomosis for the left anterior descending (LAD) branch in 61% and for the left circumflex (LCX) branch in 15%. LAD patients had more severe left cardiac dysfunction and cardiac dilatation than LCX patients.
To perform safe and reliable CAB surgery, cardiovascular surgeons should define preoperative indicators of difficult OPCAB and convert OPCAB to on-pump beating CAB intentionally without hesitation when unstable hemodynamics is detected.
为明确体外循环心脏不停跳冠状动脉搭桥术（CAB）的地位，并确定在非体外循环冠状动脉搭桥术（OPCAB）发展时代有意转为该术式的术前指标，我们评估了OPCAB引入后实施的体外循环心脏不停跳CAB。
我们评估了1999年8月（当时OPCAB被选为一线手术方式）至2004年12月期间接受单纯CAB的130例患者[117例（90%）接受OPCAB，13例（10%）接受体外循环心脏不停跳CAB]。
两组在冠状动脉病变数量或左主干（LMT）病变发生率方面未见显著差异。体外循环心脏不停跳CAB组左心功能降低、心脏扩大和二尖瓣反流（MR）更为明显。两组术前缺血情况一般都不稳定。61%的患者在左前降支（LAD）分支吻合时转为体外循环心脏不停跳CAB，15%的患者在左旋支（LCX）分支吻合时转为该术式。LAD患者比LCX患者有更严重的左心功能不全和心脏扩大。
为了进行安全可靠的CAB手术，心血管外科医生应明确困难OPCAB的术前指标，并在检测到血流动力学不稳定时毫不犹豫地有意将OPCAB转为体外循环心脏不停跳CAB。
