Bergsland Jacob, Kabil Emir, Mujanovic Emir, Terzic Ibrahim, Røislien Jo, Svennevig Jan L, Fosse Erik
The Interventional Center, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
Ann Thorac Surg. 2007 Feb;83(2):462-7. doi: 10.1016/j.athoracsur.2006.09.028.
Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery before the recent war. With assistance from the United States and Norway, a cardiovascular clinic was developed. This study reports center-specific and surgeon-specific clinical outcomes. Since off-pump coronary bypass grafting surgery was prioritized in the treatment of coronary disease, a comparison was made between operations performed with and without cardiopulmonary bypass.
Surgeons and key staff members were trained in the United States. A Norwegian data management system for cardiac surgery was implemented and cases entered after quality review of the data. A total of 1276 patients were entered; operations were performed with cardiopulmonary bypass in 540 and without in 736. The primary surgeon was entered as a variable in an anonymous fashion.
Overall mortality for coronary bypass grafting surgery was 1.6%, and the major complication rate was 4.5%. Patients operated on off-pump received fewer grafts and had a shorter length of stay. Unfavorable outcome was more common in patients when cardiopulmonary bypass was used in the operation. Regression analysis demonstrated that the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and use of cardiopulmonary bypass were predictors of poor outcome. The individual surgeon factor did not impact on outcomes.
Our study confirms that coronary artery bypass grafting surgery may be performed safely in a poor country in a hospital without experience with cardiac surgery. Selection of talented staff and cooperation with international cardiac centers are crucial. Off-pump coronary artery bypass grafting surgery is suitable for a new center and does not require more training than standard procedures.
在最近的战争之前，波斯尼亚和黑塞哥维那没有侵入性心脏诊断或心脏手术。在美国和挪威的援助下，建立了一家心血管诊所。本研究报告了特定中心和特定外科医生的临床结果。由于非体外循环冠状动脉搭桥手术在冠心病治疗中被优先考虑，因此对有和没有体外循环的手术进行了比较。
外科医生和关键工作人员在美国接受培训。实施了挪威心脏手术数据管理系统，并在对数据进行质量审查后输入病例。共输入1276例患者；540例手术使用体外循环，736例未使用。主刀医生以匿名方式作为变量输入。
冠状动脉搭桥手术的总体死亡率为1.6%，主要并发症发生率为4.5%。非体外循环手术的患者接受的移植血管较少，住院时间较短。手术中使用体外循环时，患者出现不良结局的情况更为常见。回归分析表明，欧洲心脏手术风险评估系统（EuroSCORE）和体外循环的使用是不良结局的预测因素。个体外科医生因素对结局没有影响。
我们的研究证实，在一个没有心脏手术经验的贫困国家的医院里，可以安全地进行冠状动脉搭桥手术。选拔有才能的工作人员并与国际心脏中心合作至关重要。非体外循环冠状动脉搭桥手术适用于新的中心，并且与标准手术相比不需要更多的培训。
