Herrera J M, Cuenca J, Campos V, Rodríguez F, Vicente Valle J, Juffé A
Servicio de Cirugía Cardíaca, Hospital Juan Canalejo, La Coruña.
Rev Esp Cardiol. 1998 Feb;51(2):136-40.
Coronary surgery without extracorporeal circulation is now an accepted technique of myocardial revascularization. A progressive increase in operations has recently been observed.
We report our total experience with this technique in a consecutive series of patients operated on since 1991. This series is compared with other series of patients who underwent coronary surgery using cardiopulmonary bypass.
From December 1991 to July 1996, thirty patients underwent myocardial revascularization without cardiopulmonary bypass through median sternotomy at our institution. This group was retrospectively compared with 22 patients who received isolated coronary artery bypass grafting with cardiopulmonary bypass (excluding reoperations) during the same period of time.
There were two hospital deaths and one case of myocardial infarction during the early postoperative period which required urgent reintervention. There were two variables showing a statistically significant difference between the groups with and without cardiopulmonary bypass. Incidence of non-fatal preoperative myocardial infarction increased (53% vs 23%), whereas minor mechanical ventilation time was reported (7 +/- 5 vs 14 +/- 9 h) in the group without cardiopulmonary bypass. Follow-up (1 to 55 months after operation, mean 29 months) was completed. There were no cardiac-related deaths. No return of angina nor any new myocardial infarctions were recorded. New myocardial revascularizations were not necessary.
Myocardial revascularization without extracorporeal circulation obtained good results that were similar to conventional procedures and were cost-effective.
非体外循环冠状动脉手术现已成为一种公认的心肌血运重建技术。近来观察到该手术的开展数量呈逐步上升趋势。
我们报告自1991年以来对一系列连续接受该技术手术患者的总体经验。并将该系列患者与其他接受体外循环冠状动脉手术的患者系列进行比较。
1991年12月至1996年7月，我院30例患者通过正中胸骨切开术接受了非体外循环心肌血运重建术。该组患者与同期22例接受单纯体外循环冠状动脉搭桥术（不包括再次手术）的患者进行回顾性比较。
术后早期有2例医院死亡病例和1例心肌梗死病例，后者需要紧急再次干预。有两个变量在体外循环组和非体外循环组之间显示出统计学上的显著差异。非致命性术前心肌梗死的发生率增加（53%对23%），而非体外循环组的机械通气时间较短（7±5小时对14±9小时）。完成了随访（术后1至55个月，平均29个月）。无心脏相关死亡病例。未记录到心绞痛复发或任何新的心肌梗死病例。无需进行新的心肌血运重建。
非体外循环心肌血运重建术取得了与传统手术相似的良好效果，且具有成本效益。
