Nurözler Feza, Kutlu S Tolga, Küçük Güngör
Division of Cardiovascular Surgery, Central Hospital, Izmir, Turkey.
J Cardiothorac Surg. 2006 Nov 16;1:44. doi: 10.1186/1749-8090-1-44.
The outcomes of on-pump and hybrid-pump bypass surgery in patients with depressed left ventricular function (EF<30%) were analyzed.
109 patients with preoperative left ventricular ejection fraction of <30% and bypassable circumflex coronary disease were randomized in a double blind fashion to undergo hybrid-pump (combination of off-pump and on-pump) procedure (54 patients), or on-pump coronary bypass (55 patients). In patients who underwent hybrid-pump procedure only circumflex system was bypassed on-pump to shorten CPB and myocardial ischemic time. Pre- peri and postoperative variables were analyzed.
Mean LVEF 24.4 +/- 4.8%. The patients in hybrid-pump group received less graft than others, but difference was not significant. Duration of the surgery was not different statistically between hybrid-pump and on-pump groups. A longer intraoperative duration of ischemia and extra corporeal circulation was found in on-pump group. Significant improvement in the postoperative course such as shorter mechanical ventilation, less catecholamines and IABP usage, less ICU and hospital stay, less stroke, less need for hemodyalisis and most importantly less hospital mortality was observed in hybrid-pump group.
Shortening the CPB and myocardial ischemic time and avoiding related problems, adoption of hybrid-pump strategy, in patients with severely impaired LVEF and bypassable circumflex coronary disease results in better outcome than conventional on-pump bypass.
分析了左心室功能不全（射血分数<30%）患者的体外循环心脏搭桥手术和杂交泵辅助心脏搭桥手术的结果。
109例术前左心室射血分数<30%且回旋支冠状动脉疾病适合搭桥的患者，以双盲方式随机分为接受杂交泵（非体外循环和体外循环相结合）手术组（54例）和体外循环心脏搭桥手术组（55例）。接受杂交泵手术的患者仅对回旋支系统进行体外循环搭桥，以缩短体外循环和心肌缺血时间。分析术前、术中和术后变量。
平均左心室射血分数为24.4±4.8%。杂交泵组患者接受的移植血管比其他组少，但差异不显著。杂交泵组和体外循环组手术时间在统计学上无差异。体外循环组术中缺血和体外循环时间更长。杂交泵组术后过程有显著改善，如机械通气时间缩短、儿茶酚胺和主动脉内球囊反搏使用减少、重症监护病房和住院时间缩短、中风减少、血液透析需求减少，最重要的是医院死亡率降低。
对于左心室射血分数严重受损且回旋支冠状动脉疾病适合搭桥的患者，采用杂交泵策略缩短体外循环和心肌缺血时间并避免相关问题，其结果优于传统的体外循环心脏搭桥手术。
