Darwazah Ahmad K, Bader Vivian, Isleem Ismail, Helwa Khalil
Department of Cardiac Surgery, Makassed Hospital, Jerusalem, Israel.
J Cardiothorac Surg. 2010 Nov 10;5:109. doi: 10.1186/1749-8090-5-109.
On-pump beating heart technique for myocardial revascularization has been used successfully among both low and high risk patients. Its application among low ejection fraction patients is limited. The aim of our study is to evaluate this technique among patients with low ejection fraction and to compare results with off-pump bypass technique.
This retrospective study includes 137 patients with ejection fraction below 0.35 who underwent isolated coronary artery bypass surgery. 39 patients underwent myocardial revascularization using on-pump beating heart (ONCAB/BH), while 98 patients had off-pump beating heart (OPCAB). Different preoperative, operative and postoperative variables were evaluated among both groups.
Patients profiles and risk factors were similar among both groups, except for the number of patients undergoing redo CABG which was significantly higher among ONCAB/BH (13% vs 3%; p = 0.025). Ejection fraction (EF) varied from 10-34%. The mean EF for patients who underwent ONCAB/BH was 28 ± 6 in comparison to 26 ± 5 for OPCAB patients (P = 0.093). Predicted risk for surgery according to EuroSCORE was similar among both groups (P = 0.443). The number of grafts performed per patient was significantly more among patients who underwent ONCAB/BH (2.2 ± 0.7 Vs 1.7 ± 0.7; P = 0.002). Completeness of revascularization was significantly greater in the ONCAB/BH patients (72% Vs 46%, P = 0.015). The incidence of hospital mortality and combined major morbidity was more among ONCAB/BH in comparison to OPCAB, but the difference was not significant. However, the incidence of blood loss, ventricular arrhythmias, inotropic support, ICU, hospital stay and blood transfusion were significantly greater among patients who underwent ONCAB/BH.
On-pump beating heart technique can be used in myocardial revascularization among patients with left ventricular dysfunction. The technique was found to be associated with better myocardial revascularization when compared with OPCAB technique. However, the incidence of morbidity and mortality was more than OPCAB.
体外循环心脏跳动技术已成功应用于低风险和高风险患者的心肌血运重建。其在低射血分数患者中的应用有限。我们研究的目的是评估该技术在低射血分数患者中的应用，并与非体外循环搭桥技术的结果进行比较。
这项回顾性研究纳入了137例射血分数低于0.35且接受单纯冠状动脉搭桥手术的患者。39例患者采用体外循环心脏跳动（ONCAB/BH）进行心肌血运重建，而98例患者采用非体外循环心脏跳动（OPCAB）。对两组患者术前、术中及术后的不同变量进行评估。
两组患者的概况和危险因素相似，但再次冠状动脉搭桥手术患者数量在ONCAB/BH组显著更高（13%对3%；p = 0.025）。射血分数（EF）在10%至34%之间。接受ONCAB/BH的患者平均EF为28±6，而OPCAB患者为26±5（P = 0.093）。根据欧洲心脏手术风险评估系统（EuroSCORE）预测的手术风险在两组中相似（P = 0.443）。接受ONCAB/BH的患者每位患者的移植血管数量显著更多（2.2±0.7对1.7±0.7；P = 0.002）。ONCAB/BH组患者的血运重建完整性显著更高（72%对46%，P = 0.015）。与OPCAB相比，ONCAB/BH组的医院死亡率和合并主要并发症发生率更高，但差异不显著。然而，ONCAB/BH组患者的失血量、室性心律失常、血管活性药物支持、重症监护病房（ICU）入住时间、住院时间和输血发生率显著更高。
体外循环心脏跳动技术可用于左心室功能不全患者的心肌血运重建。与OPCAB技术相比，该技术被发现与更好的心肌血运重建相关。然而，其发病率和死亡率高于OPCAB。
