Baduini G, Belli R, de Benedictis M, Bronzetti C, Corongiu M R, Alberti A, di Summa M
Divisione di Cardiologia, Ospedale Mauriziano Umberto I, Torino.
G Ital Cardiol. 1994 Dec;24(12):1529-36.
The concept of the absolute need of surgical standby for coronary angioplasty, although still strongly supported by the Task Force of the AHA and ACC, has been changing over the years according to the developments of PTCA equipment and the introduction of autoperfusion balloon catheters and coronary stents. In many European countries and in Canada, due to the relative lack of institutions performing cardiac surgery, almost 40% of cardiac laboratories are now performing PTCA without on-site surgical standby.
Following a previous experience in another institution with on-site cardiac surgery, since January 1991 until February 1994, 742 Patients underwent PTCA in our Hospital not provided with on-site cardiac surgery. Surgical standby was requested in 99 cases to nearby surgical centers and it was utilized in 6 cases. Primary success was achieved in 91% of stenoses (94% in non occlusive and 69% in totally occlusive lesions). The mortality rate in cases other than cardiogenic shock was 0.13%, the myocardial infarction rate was 1.2% and the rate of emergency coronary bypass operation was 0.8%.
PTCA in our view, as well as others', can be successfully performed in Institutions without on-site surgical support, provided the cardiac team has achieved a satisfactory experience and skill, the correct equipment for treatment of occlusive complications is available and a nearby surgical institution is alerted for procedures considered at particular risk, due to the amount of myocardium in jeopardy in case of irreversible arterial occlusion.
尽管美国心脏协会（AHA）和美国心脏病学会（ACC）特别工作组仍大力支持冠状动脉血管成形术绝对需要手术备用支持这一概念，但多年来，随着经皮冠状动脉腔内血管成形术（PTCA）设备的发展以及自灌注球囊导管和冠状动脉支架的引入，这一概念一直在发生变化。在许多欧洲国家和加拿大，由于进行心脏手术的机构相对较少，目前近40%的心脏实验室在没有现场手术备用支持的情况下进行PTCA。
基于之前在另一家有现场心脏手术的机构的经验，自1991年1月至1994年2月，我院742例患者在没有现场心脏手术的情况下接受了PTCA。99例患者被要求转至附近的外科中心进行手术备用支持，其中6例使用了该支持。91%的狭窄病变获得了初步成功（非闭塞性病变为94%，完全闭塞性病变为69%）。除心源性休克外，死亡率为0.13%，心肌梗死率为1.2%，急诊冠状动脉搭桥手术率为0.8%。
我们认为，与其他机构的观点一样，在没有现场手术支持的机构中也可以成功进行PTCA，前提是心脏治疗团队具备令人满意的经验和技能，有治疗闭塞性并发症的正确设备，并且由于在不可逆转的动脉闭塞情况下有大量心肌处于危险中，对于被认为有特殊风险的手术，要提醒附近的外科机构做好准备。
