Alford W C, Page H L, Burrus G R, Frist R A, Stoney W S, Thomas C S, Walker W E
Ann Surg. 1978 Jun;187(6):658-64. doi: 10.1097/00000658-197806000-00012.
A protocol for the operative management of two patient groups with left main coronary artery disease has been evaluated. The period prior to and during induction of anesthesia is managed without using aortic balloon counterpulsation. Of the 86 patients undergoing coronary artery bypass for left main coronary artery disease from 1970 to 1973, there was a surgical mortality of 8.1%. Follow-up of the survivors from 48 to 87 months revealed three coronary and five non-coronary related deaths with survival to seven years of 75.6 +/- 5%. If the operative mortality is excluded, there is an observed survival to seven years of 82.4 +/- 4.8%, almost the same as a "normal" population of similar age and sex. Utilizing the same protocol, 90 similar patients undergoing coronary artery bypass in 1976 had an operative mortality of 4.4%. The deaths were not related to induction of anesthesia. The perioperative infarction rate (2%) and postoperative cardiac enzyme determinations were no greater in a random group having the same operation for less severe forms of coronary artery disease during the same time period. This method of management for patients with significant left main coronary artery disease is judged superior to other more complex techniques.
对两组左主冠状动脉疾病患者的手术管理方案进行了评估。在麻醉诱导之前及期间，不使用主动脉球囊反搏进行管理。在1970年至1973年间接受左主冠状动脉疾病冠状动脉搭桥手术的86例患者中，手术死亡率为8.1%。对存活者进行48至87个月的随访发现，有3例因冠状动脉相关、5例因非冠状动脉相关死亡，7年生存率为75.6±5%。如果排除手术死亡率，观察到的7年生存率为82.4±4.8%，几乎与年龄和性别相似的“正常”人群相同。采用相同方案，1976年90例接受冠状动脉搭桥手术的类似患者手术死亡率为4.4%。死亡与麻醉诱导无关。在同一时期，对病情较轻的冠状动脉疾病进行相同手术的随机分组中，围手术期梗死率（2%）和术后心肌酶测定结果并无差异。对于患有严重左主冠状动脉疾病的患者，这种管理方法被认为优于其他更复杂的技术。
