Azarfarin Rasoul, Pourafkari Leili, Parvizi Rezayat, Alizadehasl Azin, Mahmoodian Roghaiyeh
Cardiovascular Research Center, Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Asian Cardiovasc Thorac Ann. 2010 Feb;18(1):44-8. doi: 10.1177/0218492309354126.
Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions < or = 30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction < or = 30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.
我们的目的是研究采用不同手术技术（非体外循环或体外循环）进行冠状动脉搭桥手术的患者，无论有无左心室功能障碍，其术后的医院治疗结果。在2007年3月至2008年3月期间，689例连续患者接受了首次单纯冠状动脉搭桥手术；其中127例射血分数≤30%（第1组），562例射血分数>30%（第2组）。前瞻性收集术前风险评估资料和医院治疗结果。第1组49例（38.6%）患者和第2组196例（34.9%）患者接受了非体外循环手术。第1组术后感染、神经和心脏并发症的发生率显著更高。多因素分析发现，术前射血分数≤30%是术后并发症和医院死亡率的独立危险因素。两组中接受非体外循环手术的患者亚组，其总并发症发生率显著低于接受传统体外循环手术的患者，但两组中接受非体外循环手术或传统手术患者的死亡率无显著差异。非体外循环手术有助于限制心室功能障碍患者冠状动脉搭桥术后发病率的增加。
