Kaushish Retd R, Unni M K, Luthra M
Senior Consultant, CTVS & Medical Advisor, Max Super Speciality Hospital, IP Extension, New Delhi-92.
Dy Commandant, Command Hospital (CC), Lucknow.
Med J Armed Forces India. 2010 Oct;66(4):357-61. doi: 10.1016/S0377-1237(10)80018-8. Epub 2011 Jul 21.
Off-pump Coronary Artery Bypass (OPCAB) has become the standard surgical treatment of Coronary Artery Disease in most centres in India. It is clear from the current evidence that, in certain patients, OPCAB offers advantages over conventional Coronary Artery Bypass Grafting (CABG). Experience of this procedure in the Armed Forces is highlighted.
Retrospective analysis of 200 nonrandomized consecutive patients taken up for OPCAB and 200 conventional CABG between Jan 2005 and Dec 2007 was done. The European system for cardiac operative risk evaluation (euroSCORE) was used in all patients. Perioperative morbidity and mortality was compared in the two groups.
OPCAB was possible in 192 (96 %) out of 200 patients taken up for this procedure. Eight patients required cardiopulmonary bypass (CPB) to complete the revascularization. Incidence of reoperation for bleeding was 2.5% in OPCAB and 6% in CABG In the CABG group 2% patients developed severe bleeding complications, 3% required ventilation for more than 24 hour, 1% required renal replacement therapy, 1% had acute respiratory distress syndrome and 3.5% had neuro-psychiatric manifestations. Incidence of these complications in OPCAB patients was lower or NIL. Overall mortality in the OPCAB group was 1.5% and 2% in the CABG group. However only one patient out of 192 (0.5%) who underwent successful OPCAB died, while two patients out of eight who required conversion to CPB in this group died. Incidence of stroke, deep sternal infection and mortality was similar in both groups.
OPCAB is safe, effective and can be offered to more than 90% patients as the primary strategy for surgical myocardial revascularization. It has lower overall morbidity than conventional CABG Its main limitations are hemodynamic instability and inability to find a deeply embedded target vessel. Both these factors affect the outcome adversely making conventional CABG a better option in these situations.
非体外循环冠状动脉搭桥术（OPCAB）已成为印度大多数中心治疗冠状动脉疾病的标准手术方式。从目前的证据来看，在某些患者中，OPCAB比传统冠状动脉搭桥术（CABG）具有优势。本文着重介绍了印度武装部队实施该手术的经验。
对2005年1月至2007年12月期间接受OPCAB的200例非随机连续患者和200例接受传统CABG的患者进行回顾性分析。所有患者均采用欧洲心脏手术风险评估系统（euroSCORE）。比较两组患者围手术期的发病率和死亡率。
200例接受OPCAB手术的患者中有192例（96%）成功实施了该手术。8例患者需要体外循环（CPB）来完成血管重建。OPCAB组再次手术止血的发生率为2.5%，CABG组为6%。在CABG组中，2%的患者出现严重出血并发症，3%的患者需要通气超过24小时，1%的患者需要肾脏替代治疗，1%的患者发生急性呼吸窘迫综合征，3.5%的患者出现神经精神症状。OPCAB组这些并发症的发生率较低或为零。OPCAB组的总体死亡率为1.5%，CABG组为2%。然而，192例成功接受OPCAB手术的患者中只有1例（0.5%）死亡，而该组中8例需要转为CPB的患者中有2例死亡。两组患者中风、深部胸骨感染和死亡率的发生率相似。
OPCAB安全、有效，可作为90%以上患者外科心肌血运重建的首选策略。它的总体发病率低于传统CABG。其主要局限性是血流动力学不稳定和无法找到深埋的靶血管。这两个因素都会对手术结果产生不利影响，在这些情况下，传统CABG是更好的选择。
