Perfusion-assisted direct coronary artery bypass provides early reperfusion of ischemic myocardium and facilitates complete revascularization.
Perfusion-assisted direct coronary artery bypass provides early reperfusion of ischemic myocardium and facilitates complete revascularization.
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灌注辅助直接冠状动脉搭桥术提供缺血心肌的早期再灌注并促进完全血运重建。
DOI：
10.1016/s0003-4975(02)04651-9
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
R. Guyton
中科院分区：
文献类型：
--
作者：
W. Cooper;J. Corvera;V. Thourani;J. Puskas;J. Craver;O. Lattouf;R. Guyton
研究背景灌注辅助直接冠状动脉旁路术（PADCAB）是在非体外循环手术中对移植的冠状动脉段进行早期再灌注，以解决心肌缺血发作并避免其后遗症。本病例系列概述了我们第一年的临床经验与PADCAB.METHODSFrom 1999年11月至2000年11月，169 PADCAB和358非体外循环冠状动脉旁路移植术在埃默里大学医院进行的术中发现和临床结果。使用PADCAB的决定取决于外科医生的偏好。术中记录灌注压、流量、硝酸甘油用量、总灌注时间和总灌注量。两名PADCAB患者在靶血管闭塞期间发生缺血性室性心律失常，一旦开始主动灌注，这些心律失常就消失了。PADCAB移植物的灌注压平均比平均动脉压高44%（p < 0.001）。67例患者使用硝酸甘油（通过PADCAB局部输注）缓解缺血发作并增加初始冠状动脉流量。在PADCAB组中，病变冠状动脉区域和植入的移植物的平均数量分别为2.8 ± 0.5和3.4 ± 0.7，在非体外循环冠状动脉旁路移植术组中分别为2.3 ± 0.8和2.7 ± 1.0（两种比较均为p < 0.001）。PADCAB患者接受侧壁移植物的比例高于非体外循环冠状动脉旁路移植术患者（83.4% vs 59.4%; p < 0.001）。住院死亡和术后心肌梗死组间无差异。CONCLUSIONSPADCAB可以提供超系统灌注压和一种手段，以增加血管活性药物靶向冠状动脉血管。PADCAB提供缺血心肌的早期再灌注，并促进严重多支冠状动脉疾病的完全血运重建。
BACKGROUNDPerfusion-assisted direct coronary artery bypass (PADCAB) was developed to initiate early reperfusion of grafted coronary artery segments during off-pump operations to resolve episodes of myocardial ischemia and avoid its sequelae. This case series outlines intraoperative findings and clinical outcomes of our first year clinical experience with PADCAB.METHODSFrom November 1999 to November 2000, 169 PADCAB and 358 off-pump coronary artery bypass procedures were performed at the Emory University Hospitals. The decision to use PADCAB was predicated on surgeon preference. Perfusion pressure and flow, amount of intracoronary nitroglycerin, and total perfusion time and volume were recorded at the time of operation.RESULTSOne off-pump coronary artery bypass patient required emergent conversion to cardiopulmonary bypass. Two PADCAB patients had ischemic ventricular arrhythmias during target vessel occlusion that resolved once active perfusion had begun. Perfusion pressure in PADCAB grafts was on average 44% higher than mean arterial pressure (p < 0.001). Nitroglycerin, infused locally by PADCAB, was used in 67 patients to resolve ischemic episodes and increase initial coronary flows. The mean number of diseased coronary territories and grafts placed was 2.8 ± 0.5 and 3.4 ± 0.7, respectively, in the PADCAB group, and 2.3 ± 0.8 and 2.7 ± 1.0, respectively, in the off-pump coronary artery bypass group (p < 0.001 for both comparisons). More PADCAB patients received lateral wall grafts than off-pump coronary artery bypass patients (83.4% vs 59.4%; p < 0.001). Hospital death and postoperative myocardial infarction were not different between groups.CONCLUSIONSPADCAB can provide suprasystemic perfusion pressures and a means to add vasoactive drugs to target coronary vessels. PADCAB provides early reperfusion of ischemic myocardium and facilitates complete revascularization of severe multivessel coronary artery disease.
逐渐再灌注可减少梗塞面积和内皮损伤，但会增加中性粒细胞的积累。
DOI：
10.1016/s0003-4975(97)00734-0
发表时间：
1997
期刊：
The Annals of thoracic surgery
影响因子：
--
作者：
Sato,H;Jordan,JE;Zhao,ZQ;Sarvotham,SS;Vinten-Johansen,J
通讯作者：
Vinten-Johansen,J