Guney Mehmet R, Ketenci Bulend, Yapici Fikri, Sokullu Onur, Firat Mehmet F, Uyarel Hüseyin, Yapici Nihan, Cinar Bayer, Demirtas Murat
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Istanbul, Turkey.
J Card Surg. 2009 May-Jun;24(3):227-33. doi: 10.1111/j.1540-8191.2008.00760.x. Epub 2009 Nov 18.
Emergency re-revascularization and invasive/noninvasive interventions in intensive care unit (ICU) are two main treatment methods in cardiac arrest following coronary artery bypass grafting (CABG). We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization.
Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention.
Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 +/- 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R.
Better short- and long-term results were observed in the re-revascularization group.
急诊再次血管重建以及重症监护病房（ICU）中的有创/无创干预是冠状动脉旁路移植术（CABG）后心脏骤停的两种主要治疗方法。我们评估了这两种方法的短期和长期后果，并讨论了再次血管重建的适应证。
1998年至2004年期间，共有148例CABG术后并发心脏骤停的患者接受了急诊再次血管重建治疗（n = 36，R组）和ICU治疗（n = 112，ICU组）。再次血管重建大多是根据临床/血流动力学标准进行的盲目操作。这些标准包括：复苏无反应、复发性心动过速/颤动以及复苏后严重血流动力学不稳定。仅3.3%的患者进行了再次血管造影。采用Kaplan-Meier法计算两组的无事件生存率。事件包括：死亡、复发性心绞痛、心肌梗死、心功能以及再次干预。
70%并发心脏骤停的患者发生了围手术期心肌梗死（PMI）。R组的这一发生率显著更高（p = 0.013）。R组的主要发现是移植物闭塞（91.6%）。在住院期间，两组的死亡率没有差异。然而，再次血管重建显著缩短了血流动力学稳定时间（p = 0.012）、住院时间（p = 0.00006）以及机械支持的使用时间（p = 0.003）。在平均37.1±25.1个月的随访期内，长期死亡率（p = 0.03）和无事件生存率（p = 0.029）显著有利于R组。
再次血管重建组观察到了更好的短期和长期结果。
