Puskas J D, Wright C E, Ronson R S, Brown W M, Gott J P, Guyton R A
Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, Georgia 30365, USA.
Ann Thorac Surg. 1998 Sep;66(3):1068-72. doi: 10.1016/s0003-4975(98)00657-2.
In an attempt to avoid the deleterious effects of cardiopulmonary bypass, off-pump coronary artery bypass grafting has been rediscovered and refined. The purpose of this study was to compare clinical outcomes, length of stay, and hospital costs with coronary artery bypass grafting on cardiopulmonary bypass.
Coronary artery bypass was performed on 51 patients without cardiopulmonary bypass. Patients were selected on the basis of coronary anatomy, with significant stenoses in the left anterior descending, ramus intermedius, diagonal, right coronary, acute marginal, or posterior descending territories. Outcomes were compared with those of a computer-generated matched control group having coronary artery bypass grafting on cardiopulmonary bypass (n = 248) during the same time period.
No preoperative differences were noted between groups. There were no deaths in the off-pump group and a mortality rate of 1.6% (4/248) in the control group. There was no incidence of stroke, myocardial infarction, or reentry for bleeding among patients in the off-pump group. There was a reduction in length of stay by 3 days (p = 0.01), blood transfusions by 50% (p = 0.0001), and hospital charges by one third (p = 0.05) in the off-pump group. Twenty-six patients had repeat coronary angiography before discharge; 41/43 grafts were widely patent, 1/43 was totally occluded, and 1/43 was narrowed by more than 50%. All internal mammary artery grafts were widely patent.
Off-pump multivessel cardiopulmonary bypass grafting is a safe and effective means of revascularization for patients with coronary stenoses in the anterior or inferior regions, with excellent short-term patency rates and minimal morbidity.
为避免体外循环的有害影响，非体外循环冠状动脉旁路移植术已被重新发现并得到改进。本研究的目的是比较非体外循环冠状动脉旁路移植术与体外循环冠状动脉旁路移植术的临床结果、住院时间和住院费用。
对51例患者进行非体外循环冠状动脉旁路移植术。根据冠状动脉解剖结构选择患者，其左前降支、中间支、对角支、右冠状动脉、急性边缘支或后降支区域存在明显狭窄。将结果与同期计算机生成的接受体外循环冠状动脉旁路移植术的匹配对照组（n = 248）进行比较。
两组术前无差异。非体外循环组无死亡病例，对照组死亡率为1.6%（4/248）。非体外循环组患者无中风、心肌梗死或再次出血的发生率。非体外循环组住院时间缩短3天（p = 0.01），输血减少50%（p = 0.0001），住院费用降低三分之一（p = 0.05）。26例患者在出院前进行了重复冠状动脉造影；43根移植血管中有41根通畅良好，1根完全闭塞，1根狭窄超过50%。所有胸廓内动脉移植血管均通畅良好。
非体外循环多支血管冠状动脉旁路移植术是治疗前壁或下壁冠状动脉狭窄患者的一种安全有效的血运重建方法，短期通畅率极佳，发病率极低。
