Mishra Yugal K, Collison Sathiakar Paul, Malhotra Rajneesh, Kohli Vijay, Mehta Yatin, Trehan Naresh
Escorts Heart Institute and Research Centre, New Delhi, India.
J Thorac Cardiovasc Surg. 2008 Mar;135(3):527-32. doi: 10.1016/j.jtcvs.2007.10.019.
Patients undergoing reoperative coronary artery bypass have increased mortality and morbidity compared with those undergoing primary coronary bypass. The experience in applying off-pump techniques to coronary reoperations is limited. In this article we report a 10-year experience using various techniques of reoperative off-pump coronary bypass.
Between January 1996 and December 2005, 332 patients underwent reoperative off-pump coronary artery bypass grafting. Data were collected regarding the preoperative, intraoperative, and postoperative clinical course of all patients. These were compared with similar data obtained from patients who had undergone conventional coronary reoperation during this period.
Two hundred ninety-six (89.2%) male and 36 female patients underwent reoperative off-pump coronary artery bypass. Of these, 265 (79.8%) patients underwent multivessel bypass through a median sternotomy, an anterolateral thoracotomy was performed in 63 (19%) patients, and a posterolateral thoracotomy was performed in 4 (1.2%) patients. The early mortality for patients undergoing off-pump surgery was lower than for those undergoing conventional reoperations (3.3% vs 5.5%, P = .066). Those who had undergone off-pump reoperations had less need for prolonged ventilation or prolonged inotropic support and had shorter intensive care unit and hospital stays than patients who had undergone redo coronary artery bypass grafting.
For many patients requiring coronary reoperations, off-pump techniques are safe and feasible. Complete revascularization was achieved in at least 75% of patients in an unselected population, with mortality and perioperative event rates that are comparable with those of conventionally performed coronary reoperations.
与初次冠状动脉搭桥手术患者相比，再次进行冠状动脉搭桥手术的患者死亡率和发病率更高。非体外循环技术应用于冠状动脉再次手术的经验有限。在本文中，我们报告了10年使用各种非体外循环冠状动脉再次搭桥技术的经验。
1996年1月至2005年12月期间，332例患者接受了非体外循环冠状动脉搭桥术。收集了所有患者术前、术中和术后的临床过程数据。将这些数据与同期接受传统冠状动脉再次手术患者的类似数据进行比较。
296例（89.2%）男性和36例女性患者接受了非体外循环冠状动脉搭桥术。其中，265例（79.8%）患者通过正中胸骨切开术进行多支血管搭桥，63例（19%）患者进行了前外侧开胸手术，4例（1.2%）患者进行了后外侧开胸手术。非体外循环手术患者的早期死亡率低于传统再次手术患者（3.3%对5.5%，P = 0.066）。与接受再次冠状动脉搭桥术的患者相比，接受非体外循环再次手术的患者对延长通气或延长强心支持的需求更少，重症监护病房和住院时间更短。
对于许多需要进行冠状动脉再次手术的患者，非体外循环技术是安全可行的。在未选择的人群中，至少75%的患者实现了完全血运重建，死亡率和围手术期事件发生率与传统冠状动脉再次手术相当。
