Tabata Minoru, Takanashi Shuichiro, Horai Tetsuya, Fukui Toshihiro, Hosoda Yasuyuki
Department of Cardiovascular Surgery, Shin-Tokyo Hospital, 473-1, Nemoto, Matsudo-Shi, Chiba 271-0077, Japan.
Interact Cardiovasc Thorac Surg. 2006 Oct;5(5):555-9. doi: 10.1510/icvts.2006.128884. Epub 2006 Jun 15.
Emergency conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting is recognized to increase operative mortality and morbidity. We conducted a retrospective review of 616 consecutive patients who were planned for off-pump coronary artery bypass grafting from April 2001 to July 2004. Fourteen patients (2.3%) required emergency conversion to cardiopulmonary bypass. Operative mortality was 13.3% in the conversion group and 1.2% in the non-conversion group (P<0.001). The incidence of reoperation for bleeding was 7.1% and 1.0%, respectively (P=0.032) and that of respiratory failure was 35.7% and 3.3%, respectively (P<0.001). Multivariable analysis showed that mitral regurgitation and chronic obstructive pulmonary disease were predictors of emergency conversion with all causes except for bleeding, and that mitral regurgitation and no use of a heart positioning device were predictors of emergency conversion due to hemodynamic compromise during distal anastomosis of the circumflex artery territory. In conclusion, emergency conversion in off-pump coronary artery bypass grafting increases operative mortality and morbidity. Mitral regurgitation and chronic obstructive pulmonary disease are risk factors for emergency conversion. Use of a heart positioning device decreases hemodynamic compromise during anastomosis of the circumflex artery territory.
非体外循环冠状动脉旁路移植术中紧急转为体外循环被认为会增加手术死亡率和发病率。我们对2001年4月至2004年7月计划进行非体外循环冠状动脉旁路移植术的616例连续患者进行了回顾性研究。14例患者（2.3%）需要紧急转为体外循环。转为体外循环组的手术死亡率为13.3%，未转为体外循环组为1.2%（P<0.001）。再次手术止血的发生率分别为7.1%和1.0%（P=0.032），呼吸衰竭的发生率分别为35.7%和3.3%（P<0.001）。多变量分析显示，二尖瓣反流和慢性阻塞性肺疾病是除出血外所有原因导致紧急转为体外循环的预测因素，二尖瓣反流和未使用心脏定位装置是在回旋支动脉区域远端吻合期间因血流动力学不稳定导致紧急转为体外循环的预测因素。总之，非体外循环冠状动脉旁路移植术中紧急转为体外循环会增加手术死亡率和发病率。二尖瓣反流和慢性阻塞性肺疾病是紧急转为体外循环的危险因素。使用心脏定位装置可减少回旋支动脉区域吻合期间的血流动力学不稳定。
