Cartier R, Bouchard D, Martineau R
Service de Chirurgie, Institut de Cardiologie de Montréal, Québec, Canada.
Ann Chir. 1998;52(8):801-6.
To compare the perioperative benefits of the offpump coronary artery surgery to conventional surgery with cardiopulmonary bypass (CPB) assistance.
Retrospective study comparing 50 consecutive patients with triple vessel disease (TVD) operated upon with CPB assistance to 50 consecutive patients with TVD operated on beating heart (BH) by the same surgeon between January 1996 and August 1997 at the Montreal Heart Institute. Matching criteria between the 2 groups were: first time operation, normal left ventricular ejection function (LVEF), and coronary TVD.
Demographic data and risk factors were comparable in both groups. Unstable angina was the most common surgical indication (CBP: 72%, BH: 62%). The average number of grafts were comparable in both groups (CBP: 3.5 vs 0.6 vs BH: 3.3 +/- 0.4, p = 0.06) as well as the preoperative LVEF (CEC: 60 +/- 1% vs CB: 62 +/- 1.2%, p = 0.38). Arterial lactate count was lower in the BH group during the perioperative period (3.0 +/- 1.0 vs 3.9 +/- 1.7 mM) as well as the maximal CK-MB level (BH: 20 +/- 6.4 vs CBP: 40 +/- 3.5 IU/L, p = 0.003), transfusional needs (CB: 34% vs CEC: 66%, p = 0.003), and postoperative creatinin level (BH: 100 +/- 4.2 vs CBP: 120 +/- 7.1 mM, p = 0.001). Postoperative HB level was also higher in the BH group (110 +/- 14 vs 104 +/- 12, p = 0.001).
Our data confirm potential benefits from BH surgery on patients affected with triple vessel disease relatively to transfusional needs, and myocardial as well as renal protection.
比较非体外循环冠状动脉手术与传统体外循环（CPB）辅助手术的围手术期益处。
回顾性研究，比较1996年1月至1997年8月在蒙特利尔心脏研究所由同一位外科医生对50例接受CPB辅助的三支血管病变（TVD）连续患者与50例接受心脏不停跳（BH）手术的TVD连续患者进行研究。两组之间的匹配标准为：首次手术、左心室射血功能（LVEF）正常和冠状动脉TVD。
两组的人口统计学数据和危险因素具有可比性。不稳定型心绞痛是最常见的手术指征（CPB组：72%，BH组：62%）。两组的平均移植血管数量具有可比性（CPB组：3.5±0.6对BH组：3.3±0.4，p = 0.06）以及术前LVEF（CPB组：60±1%对BH组：62±1.2%，p = 0.38）。围手术期BH组的动脉乳酸计数较低（3.0±1.0对3.9±1.7 mM）以及最大CK-MB水平（BH组：20±6.4对CPB组：40±3.5 IU/L，p = 0.003）、输血需求（CPB组：34%对BH组：66%，p = 0.003）和术后肌酐水平（BH组：100±4.2对CPB组：120±7.1 mM，p = 0.001）。BH组术后血红蛋白水平也较高（110±14对104±12，p = 0.001）。
我们的数据证实，对于三支血管病变患者，与输血需求以及心肌和肾脏保护相关，BH手术具有潜在益处。
