Fanning W J, Kakos G S, Williams T E
Division of Thoracic Surgery, Grant Medical Centers, Columbus, Ohio.
Ann Thorac Surg. 1993 Feb;55(2):486-9. doi: 10.1016/0003-4975(93)91025-i.
Between June 1979 and January 1992, 46 men and 13 women aged 35 to 81 years (mean, 58 years) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex bypass was performed through a left thoracotomy, and reoperative bypass to the right coronary artery and left anterior descending coronary systems was through a median sternotomy. Complete revascularization was the goal in all patients. Saphenous vein grafts were placed to the right coronary artery (n = 21), circumflex artery (n = 11), and left anterior descending artery (n = 24), and 14 internal thoracic artery to left anterior descending artery bypass grafts were performed. The overall mortality rate was 3.4% (2 deaths). Postoperative morbidity included myocardial infarction in 1 patient and pleuropulmonary complications in 6. No patient was reexplored for hemorrhage, and 19 patients required no blood products. Twenty patients underwent repeat coronary angiography, and 18 of 20 grafts placed without cardiopulmonary bypass were patent. At a mean follow-up interval of 42.2 months 35 of 50 evaluable patients were in functional class I or II. In selected patients, reoperative coronary artery bypass grafting can be performed without cardiopulmonary bypass with a low perioperative morbidity and mortality rate, satisfactory graft patency rates, and good long-term symptomatic improvement.
1979年6月至1992年1月期间，46例男性和13例女性，年龄在35至81岁（平均58岁），接受了非体外循环下再次冠状动脉搭桥手术。单纯再次回旋支搭桥手术通过左胸廓切开术进行，再次右冠状动脉和左前降支冠状动脉系统搭桥手术通过正中胸骨切开术进行。所有患者的目标都是完全血运重建。将大隐静脉移植到右冠状动脉（n = 21）、回旋支动脉（n = 11）和左前降支动脉（n = 24），并进行了14例胸廓内动脉至左前降支动脉的搭桥手术。总死亡率为3.4%（2例死亡）。术后并发症包括1例心肌梗死和6例胸膜肺部并发症。没有患者因出血而再次手术探查，19例患者不需要血液制品。20例患者接受了重复冠状动脉造影，20例非体外循环下放置的移植物中有18例通畅。在平均42.2个月的随访期内，50例可评估患者中有35例处于功能I级或II级。对于选定的患者，非体外循环下再次冠状动脉搭桥手术可在围手术期发病率和死亡率较低、移植物通畅率令人满意且长期症状改善良好的情况下进行。
