左主干冠状动脉狭窄在非体外循环冠状动脉搭桥术中对术中中转及死亡率的影响
Role of Left Main Coronary Artery Stenosis on Intraoperative Conversion and Mortality in Off-Pump Coronary Artery Bypass.
作者信息
Chen Jeng-Wei, Lin Cheng-Hsin, Hsu Ron-Bin
机构信息
Department of Surgery, National Taiwan University Hospital, Hsin- Chu Branch; ; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
Acta Cardiol Sin. 2014 Nov;30(6):522-8. doi: 10.6515/acs20140929a.
BACKGROUND
Intraoperative conversion is a major threat in off-pump coronary artery bypass (OPCAB). The conversion rate depends on patient selection and surgeon experience. Previous studies have demonstrated the feasibility of OPCAB for patients with left main coronary artery stenosis (LMCAS) ≥ 50%. However, no studies have focused on the role of LMCAS ≥ 90%. We sought to assess the impact of LMCAS ≥ 90% on the conversion rate and mortality in OPCAB.
METHODS
We conducted a retrospective review of 1055 consecutive unselected patients undergoing OPCAB between 2000 and 2012. The patients in our study were divided into 3 groups by the severity of LMCAS.
RESULTS
LMCAS was < 50% in 704, 50-90% in 266, and ≥ 90% in 85 patients. LMCAS was not associated with major postoperative complications and hospital mortality, although preoperative cardiogenic shock was present in 6.3%. Overall, the conversion rate was 10.1%:11.4% in LMCAS < 50%, 5.6% in LMCAS 50-90%, and 14.1% in LMCAS ≥ 90%. Operation status, cardiogenic shock, left ventricular ejection fraction < 30% and operation before 2007 were noted as independent predictors of conversion. The overall hospital mortality rate was 5.1%: 4.8% in LMCAS < 50%, 4.5% in LMCAS 50-90%, and 9.4% in LMCAS ≥ 90%. Operation status, cardiogenic shock, left ventricular ejection fraction < 30% and intraoperative conversion were observed to be independent predictors of mortality. However, LMCAS did not predict either conversion or hospital mortality.
CONCLUSIONS
LMCAS ≥ 90% was not an independent predictor of intraoperative conversion or hospital mortality in OPCAB.
KEY WORDS
Conversion; Left main coronary artery stenosis; Off-pump coronary artery bypass.
背景
术中中转是非体外循环冠状动脉搭桥术（OPCAB）的一个主要威胁。中转率取决于患者的选择和外科医生的经验。以往研究已证明OPCAB用于左主干冠状动脉狭窄（LMCAS）≥50%患者的可行性。然而，尚无研究关注LMCAS≥90%的作用。我们旨在评估LMCAS≥90%对OPCAB中转率和死亡率的影响。
方法
我们对2000年至2012年间连续1055例接受OPCAB的未经过筛选的患者进行了回顾性研究。我们研究中的患者根据LMCAS的严重程度分为3组。
结果
704例患者LMCAS<50%，266例患者LMCAS为50%-90%，85例患者LMCAS≥90%。LMCAS与术后主要并发症及院内死亡率无关，尽管6.3%的患者术前存在心源性休克。总体而言，中转率为10.1%：LMCAS<50%组为11.4%，LMCAS 50%-90%组为5.6%，LMCAS≥90%组为14.1%。手术状态、心源性休克、左心室射血分数<30%以及2007年前手术被视为中转的独立预测因素。总体院内死亡率为5.1%：LMCAS<50%组为4.8%，LMCAS 50%-90%组为4.5%，LMCAS≥90%组为9.4%。手术状态、心源性休克、左心室射血分数<30%以及术中中转被观察为死亡率的独立预测因素。然而，LMCAS并不能预测中转或院内死亡率。
结论
LMCAS≥90%并非OPCAB术中中转或院内死亡率的独立预测因素。
关键词
中转；左主干冠状动脉狭窄；非体外循环冠状动脉搭桥术
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